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. 2025 Feb 17;5(3):278–286. doi: 10.1016/j.jncc.2025.01.003

The epidemiological landscape of lung cancer: current status, temporal trend and future projections based on the latest estimates from GLOBOCAN 2022

Yuting Ji 1,†, Yunmeng Zhang 1,†, Siwen Liu 1, Jingjing Li 1, Qianyun Jin 1, Jie Wu 1, Hongyuan Duan 1, Xiaomin Liu 1, Lei Yang 2,3,⁎, Yubei Huang 1,⁎
PMCID: PMC12276566  PMID: 40693237

Abstract

Background

Given the relatively unfavorable prognosis and significant geographic differences in lung cancer burden, it is critical to update the global landscape of lung cancer to inform local strategies.

Methods

Based on the GLOBOCAN 2022, the age-standardized incidence rate (ASIR) and mortality rate (ASMR) were compared and linked to the Human Development Index (HDI) across different populations. The temporal trends in ASIR/ASMR were characterized as estimated annual percentage change (EAPC), and demographic projections were performed up to 2050.

Results

Globally, an estimated 2,480,675 cases and 1,817,469 deaths from lung cancer occurred in 2022. Both ASIR and ASMR of lung cancer varied widely by world region, with ASIR ranging from 2.06 to 39.38 per 100,000 and ASMR from 1.95 to 31.70 per 100,000. China alone accounted for >40 % of cases and deaths worldwide. Both ASIR and ARMR of lung cancer increased with HDI (R2: 0.54 and 0.47, all P values <0.001), regardless of gender. Based on available data, both ASIR during 2001–2010 and ASMR during 2001–2015 showed decreasing trends in males (EAPC: 1.50 % and −2.22 %) but increasing trends in females (EAPC: 1.08 % and 0.07 %). Similar trends in ASIR and ASMR were observed among the elder population (≥50 years); however, downward trends were observed in the younger population (<50 years). Alongside the aging and growth of the population, estimated cases and deaths from overall lung cancer would increase by 86.2 % and 95.2 % up to 2050 as compared with estimates in 2022, respectively. Notably, increased early-onset lung cancer was only observed in transitioning countries, while decreased early-onset lung cancer was observed in transitioned countries.

Conclusion

Lung cancer maintained as the leading cancer burden worldwide. Unless timely preventive interventions in tobacco mitigation, early screening, and precise treatment, the global lung cancer burden is expected to increase in the future, especially for transitioning countries.

Keywords: Lung cancer, incidence, mortality, temporal trend, HDI

1. Introduction

Lung cancer is one of the most commonly diagnosed cancers and the leading cause of cancer-related deaths worldwide.1 According to the estimates from the GLOBOCAN 2022, >2.48 million new cases of lung cancer (12.4 %) and 1.82 million deaths from lung cancer (18.7 %) occurred in 2022, which present lung cancer as the most common type of cancer and the first leading cause of cancer deaths.2 Although the incidence of male lung cancer in the some countries has been declining due to a series of effective tobacco control measures, the rates in females are still rising.3 Differences in smoking prevalence cannot fully explain the sex differences in lung cancer incidence. Moreover, the smoking prevalence has either peaked recently or continues to increase in most transitioning countries.4, 5 However, few studies have investigated the global differences in the gender-specific temporal trend of lung cancer burden.

Regional and country-specific studies suggested a potential increasing trend in lung cancer patients younger than 50 years,6,7 and higher incidence of lung cancer was observed among young women than among young men in the United States.8 However, few studies have investigated the global temporal trend in lung cancer rates by age and sex. A potential link between socioeconomic development and lung cancer has also been suggested in previous studies,9, 10, 11 but fewer studies have explored the link globally. More concernedly, based on the CONCORD-3 and the ICBP SURVMARK-2 studies, age-standardized 5-year net survival of lung cancer only ranged 10–20 % in most countries, which was much lower than that of all-site cancer.12,13 Even among the countries with high and very high Human Development Index (HDI), the lung cancer survival rate was also at a relatively unfavorable level.14,15

Given the overwhelming burden due to smoking, contrasting geographic and sex differences, unclear global trends by age and sex, and unfavorable prognosis in lung cancer, it is vital to timely update the global landscape of lung cancer to inform local strategies. Therefore, based on the latest GLOBOCAN 2022 estimates of cancer incidence and mortality released by the International Agency for Research on Cancer (IARC), we aimed to present a description of lung cancer incidence and mortality at the global level and an assessment of the geographic and sex difference across 21 predefined world regions. Then we tried to describe the changing trend of lung cancer burden over the past decades and end with a description of future lung cancer burden up to 2050 based on global demographic projections.

2. Materials and methods

2.1. Data sources

Raw data on cancer burden released by countries around the world are aggregated and measured by the IARC under the World Health Organization (WHO) according to uniform standards to form the GLOBOCAN database. Up until 2024, the GLOBOCAN database presents the estimated burden of 36 malignant cancers in 185 countries or territories worldwide, providing the best data for describing and comparing the burden of lung cancer on a global scale.2 All data related to lung cancer burden included in this study were obtained from the GLOBOCAN database (https://gco.iarc.fr/). Particularly, data from the Cancer Today database were extracted to present the current estimates of lung cancer cases and deaths in 2022.16 Data from the Cancer Incidence in Five Continents (CI5 plus) database and the WHO mortality database were used to estimate the temporal trend of lung cancer incidence and mortality over the past.17 Data from the Cancer Tomorrow database was extracted to present the predicted estimates of lung cancer cases and deaths up until 2050.

2.2. Selected countries and indicators

In 2022, the regional lung cancer burden was majorly presented according to 21 aggregated regions defined by the United Nations (UN) Population Division, and 21 countries with the highest age-specific standardized incidence rate (ASIR) of lung cancer within each UN region were selected to present the national lung cancer burden. To visualize and compare the temporal trends in ASIR and age-specific standardized mortality rate (ASMR) of lung cancer, all available national data with continuous monitoring over the same period were included to calculate the estimated annual percentage change (EAPC) in ASIR and ASMR. Based on the UN Development Program's Human Development Report 2021–22,18 the HDI, which was calculated based on life expectancy, education index, and gross domestic income per capital, was used to present the difference in lung cancer burden across countries with different levels of development. Based on HDI database 2021, all countries were reclassified into four groups based on HDI: low (HDI<0.55), medium (HDI 0.55–0.70), high (HDI 0.70–0.79), or very high (HDI ≥0.80).19,20 Throughout, the terms transitioning HDI countries were used as synonyms for countries classified as low and medium HDI, while the terms transitioned HDI countries were used for those classified as high and very high HDI.

2.3. Statistical analysis

The Segi's world standard population was used to calculate the ASIR and ASMR of lung cancer for comparison between different populations.21 UN regional and country-specific lung cancer ASIR and ASMR in 2022 were calculated, and subgroup estimates were further conducted by gender. A linear regression model was used to estimate the association of ASIR and ASMR with HDI. The EAPC was calculated using a generalized linear model (GLM) to characterize the trend in ASIR and ASMR over the time period selected after considering a Gaussian distribution for the ASIR and ASMR.17 Demographic projections of lung cancer cases and deaths were performed from the estimates in 2022 up until 2050 after assuming that the projected changes in population growth and aging, and the national rates estimated in 2022 remain stable in the future.16 Percentage changes in the number of lung cancer cases and deaths were calculated as the predicted estimates in 2050 minus the estimates in 2022 and then divided by the latter. Then the percentage changes were grouped by HDI countries and gender. To further characterize the age-stratified burden of lung cancer, early-onset, and late-onset lung cancer was defined as whether the age at diagnosis of cancer is younger or older than 50 years old (0–49 versus ≥50 years).

All statistical analyses were performed with R software (version 4.2.3), Microsoft Excel (version 4.2.3), and the Global Cancer Observatory online, and P value <0.05 was considered statistically significant.

3. Results

3.1. Global status of lung cancer incidence and mortality in 2022

Globally, the estimated lung cancer new cases and deaths were 2,480,675 and 1,817,469 in 2022, responsible for close to one in eight (12.4 %) cancers diagnosed and one in five (18.7 %) cancer deaths. Within all-sites cancer new cases and deaths worldwide, lung cancer ranked as the first commonly diagnosed cancer and the first leading cause of cancer-related death, irrespective of the HDI level. The global ASIR and ASMR of lung cancer were 23.60 and 16.80 per 100,000, respectively. Overall, both ASIR and ASMR of lung cancer were approximately twice as common in men as in women (ASIR: male vs. female, 32.10 vs. 16.20 per 100,000; ASMR: 24.80 vs. 9.80 per 100,000), although the male-to-female ratios varied widely across UN regions.

According to the UN regions, more than half of the lung cancer new cases and nearly half of the lung cancer deaths occurred in East Asia (50.14 % and 46.87 %, respectively). The highest difference of ASIR among UN regions was 19.12, and the highest difference of ASMR among UN regions was 16.26 times. The top 5 UN regional lung cancer ASIRs were observed in Eastern Asia (39.38 per 100,000), Polynesia (37.48 per 100,000), Northern America (31.92 per 100,000), Micronesia (31.57 per 100,000), and Western Europe (31.22 per 100,000) (Fig. 1A), while the top 5 UN regional lung cancer ASMRs were observed in Polynesia (31.70 per 100,000), Micronesia (30.52 per 100,000), Eastern Asia (25.13 per 100,000), Western Europe (22.11 per 100,000), and Eastern Europe (21.57 per 100,000)(Fig. 1D). Among the males, Polynesia had the highest ASIR and ASMR, which were 54.66 (per 100,000) and 47.62 (per 100,000), respectively (Fig. 1B and D). Among the females, the highest ASIR and ASMR were observed in Northern America (30.40 per 100,000) and Micronesia (17.94 per 100,000), respectively (Fig. 1C and F, and Supplementary Table 1).

Fig. 1.

Fig 1

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National ASIR and ASMR of lung cancer grouped by UN regions and sex in 2022. Note: ASIR, age‐standardized incidence rate. ASMR, age‐standardized mortality rate. UN, the United Nations. (A) National ASIR of lung cancer for male and female. (B) National ASIR of lung cancer for male. (C) National ASIR of lung cancer for female. (D) National ASMR of lung cancer for male and female. (E) National ASMR of lung cancer for male. (F) National ASMR of lung cancer for female. Inline graphic, ASIR of lung cancer for UN regions. Inline graphic, ASIR of lung cancer for countries in UN regions. Inline graphic, ASIR of lung cancer for UN regions. Inline graphic, ASIR of lung cancer for countries in UN regions.

At the country level, China alone accounted for >40 % of lung cancer new cases (1,060,584; 42.75 %) and deaths (733,291; 40.35 %) worldwide. The top 5 national lung cancer ASIR were observed in Hungary (47.57 per 100,000), New Caledonia (41.77 per 100,000), China (40.78 per 100,000), Serbia (40.39 per 100,000), and French Polynesia (39.95 per 100,000) (Fig. 1A), while the top 5 national lung cancer ASMR were observed in Hungary (39.80 per 100,000), Türkiye (35.06 per 100,000), French Polynesia (34.95 per 100,000), Serbia (33.39 per 100,000), and New Caledonia (30.99 per 100,000) (Fig. 1D). Among the males, the highest national rates were observed in Türkiye (ASIR vs. ASMR, 67.99 vs. 66.25 per 100,000), followed by Hungary (ASIR vs. ASMR, 64.36 vs. 54.49 per 100,000) and Serbia (ASIR vs. ASMR, 59.60 vs. 49.38 per 100,000) (Fig. 1B and D). Among the females, the highest national rates were observed in Hungary (ASIR vs. ASMR, 34.96 vs. 28.88 per 100,000), followed by Demark (ASIR vs. ASMR, 34.40 vs. 23.61 per 100,000) (Fig. 1C and F, and Supplementary Table 2).

3.2. Link between lung cancer incidence and mortality with HDI

Linear regression analyses showed that lung cancer ASIR increased with HDI among the whole population (Fig. 2A, R2=0.54, P < 0.001), regardless of gender (male: R2=0.44, P < 0.001, Fig. 2B; female: R2=0.50, P < 0.001, Fig. 2C). Meanwhile, a similar positive correlation between HDI and lung cancer ASMR was also observed for both sexes (overall: R2=0.47, P < 0.001, Fig. 2D; male: R2=0.37, P < 0.001, Fig. 2E; female: R2=0.47, P < 0.001, Fig. 2F).

Fig. 2.

Fig 2

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Link between HDI and ASIR and ASMR of lung cancer on 2022. (A) Link between HDI and ASIR of lung cancer for male and female; (B) Link between HDI and ASIR of lung cancer for male; (C) Link between HDI and ASIR of lung cancer for female; (D) Link between HDI and ASMR of lung cancer for male and female; (E) Link between HDI and ASMR of lung cancer for male; (F) Link between HDI and ASMR of lung cancer for female. ASIR, age-standardized incidence rate; ASMR, age-standardized mortality rate; HDI, Human Development Index.

3.3. Temporal trend in ASIR and ASMR of global lung cancer

During 2001–2010, the overall ASIR of lung cancer showed a decreasing trend in males (EAPC: −1.50 %) and an increasing trend in females (EAPC: 1.08 %) worldwide (Fig. 3A and D), while overall ASMR during 2001–2015 also showed a decreasing trend in males (EAPC: −2.22 %) and an increasing trend in females (EAPC: 0.07 %) (Fig. 4A and D). Among the male population, the top three decreased EAPCs in lung cancer ASIR were −4.55 % in Colombia, −4.33 % in Uganda, and −3.09 % in China (Fig. 3A); and those in ASMR were −4.30 % in Mexico, −3.67 % in Czechia, and −3.17 % in the USA (Fig. 4A). Among the female population, the top three increased EAPCs in lung cancer ASIR were 7.04 % in Malta, 6.23 % in Spain, and 5.96 % in India (Fig. 3D), while those in ASMR were 4.48 % in Spain, followed by 4.30 % in Uruguay and 3.81 % in Malta (Fig. 4D).

Fig. 3.

Fig 3

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Temporal trends in age-standardized lung cancer incidence by country, sex, and age during 2001–2010. (A) EAPC for lung cancer incidence among males, 0–85+ years; (B) EAPC for lung cancer incidence among males, 0–49 years; (C) EAPC for lung cancer incidence among males, 50+ years; (D) EAPC for lung cancer incidence among females, 0–85+ years; (E) EAPC for lung cancer incidence among females, 0–49 years; and (F) EAPC for lung cancer incidence among females, 50+ years. EAPC, estimated annual percentage change.

Fig. 4.

Fig 4

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Temporal trends in age-standardized lung cancer mortality by country, sex, and age during 2001–2015. (A) EAPC for lung cancer mortality among males, 0–85+ years; (B) EAPC for lung cancer mortality among males, 0–49 years; (C) EAPC for lung cancer mortality among males, 50+ years; (D) EAPC for lung cancer mortality among females, 0–85+ years; (E) EAPC for lung cancer mortality among females, 0–49 years; and (F) EAPC for lung cancer mortality among females, 50+ years. EAPC, estimated annual percentage change.

After stratified by age, both the ASIR and ASMR of early-onset (<50 years) lung cancer showed a decreasing trend in males (EAPC in ASIR and ASMR: −3.53 % and −5.34 %) and females (EAPC: −0.70 % and −3.17 %) worldwide (Fig. 3B, E, and Fig. 4B, E). The ASIR and ASMR of late-onset (≥50 years) lung cancer showed a decreasing trend in males (EAPC in ASIR and ASMR: −1.25 % and −2.06 %) and an increasing trend in females (EAPC: 1.59 % and 0.36 %) (Fig. 3C, F, and Fig. 4C, F).

3.4. Future burden of lung cancer

Based on the population growth and aging, and assuming national rates remain unchanged, the estimated lung cancer new cases are projected to be 4,620,066 in 2050, with an increased percentage of 86.20 % as compared with the estimate in 2022. The estimated lung cancer deaths are projected to be 3,547,874 in 2050, with an increased percentage of 95.20 % as compared with the estimate in 2022.

The burden of lung cancer will increase substantially at all HDI levels, and the greatest absolute increase in estimated lung cancer cases in 2050 will be observed in countries with high HDI (including China), followed by countries with very high HDI (with an additional 1.05 and 0.45 million cases, respectively). However, the highest relative increase in both new cases and deaths will be observed in countries with low HDI (154.5 % and 155.0 %), regardless of gender. Similar increased percentage will be observed in projected late-onset lung cancer. Notably, obviously increased percentages in early-onset cancer burden will be only observed in countries with low and medium HDI (127.0 % and 41.4 %), but a decreased percentage in early-onset cancer burden will be observed in countries with very high HDI (Fig. 5, Supplementary Fig. 1, and Supplementary Fig. 2).

Fig. 5.

Fig 5

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Predicted percentage changes of global lung cancer new cases and deaths by HDI between 2022 and 2050. (A) Predicted percentage change of global lung cancer new cases; (B) Predicted percentage change of global lung cancer deaths. HDI, Human Development Index.

4. Discussion

In this study, we provided the most up-to-date global landscape of lung cancer, including current status, temporal trends, and future projections. We reaffirmed a series of worrying facts associated with lung cancer worldwide, including marked geographic differences in both morbidity and mortality, relatively heavier burden for males versus females, and obvious increase with socioeconomic development. More worryingly, lung cancer maintained as the leading cause of cancer morbidity and mortality worldwide, irrespective of the HDI level. We consolidated the globally decreased trend in male lung cancer incidence but increased trend in female. Alongside the aging and growth of the population, both cases and deaths from lung cancer would significantly increase in the future. All these facts caused great pressure on the current public health services. How to deal with this global epidemic of lung cancer has become a major public health crisis faced by most countries.

When the smoking epidemic (steep increase, peak, and subsequent decline) was first established among men in several high-income countries (e.g., the United Kingdom and the United States), the corresponding epidemic of lung cancer incidence was first reported at the same countries albeit a 20–25 years lag.22,23 Currently, in most transitioned countries, male smoking generally has passed the peak stage in the 1980s and arrived at the advanced phase due to a series of effective tobacco control policies.3,24,25 However, the men smoking prevalence remains at an earlier stage, either peaked recently or continues to increase, in most transitioning countries,4 and hence lung cancer rates would likely increase for at least the next decade,26 especially among countries with the top highest male age-standardized smoking prevalence, such as Indonesia (46.7 %), Russia (38.2 %), Bangladesh (38.0 %), and China (37.5 %).27 Unlike the high smoking prevalence among men, only a small percentage of women (<5 %) are daily smokers in several transitioning countries, including Indonesia (3.8 %), China (2.2 %), and Bangladesh (1.8 %).27 Globally, nearly one-quarter of the lung cancer burden could be attributable to causes other than tobacco smoking,28,29 and nonsmoker lung cancer constitutes a significant proportion of the overall disease burden. Passive smoking and environmental exposures (including household burning of biomass fuels for heating and cooking, outdoor ambient air pollution, and special occupation exposure (such as asbestos, arsenic, and radon) may partially explain these patterns.28, 29, 30, 31 Currently, substantial and increasing evidence from studies of humans and experimental animals as well as mechanistic evidence support the causal link between outdoor (ambient) air pollution, and especially outdoor particulate matter (PM), with lung cancer incidence and mortality.32, 33, 34 The global proportion of lung cancer deaths attributable to outdoor ambient PM2.5 air pollution was 14 % in 2017, ranging from 4.7 % in the United States to 20.5 % in China.35

Both incidence and mortality of lung cancer increased with HDI, and it was more significant in males, which was consistent with the results of previous studies.36, 37, 38, 39 The link between HDI and lung cancer incidence not only reflects a relatively higher prevalence of smoking in countries with a higher HDI albeit a decline of male smoking prevalence among most transitioned countries,11,40, 41, 42 but also largely reflects the aging and growth of the population as well as changes in socioeconomic development in higher HDI countries. The impact of aging on health is particularly evident in current China, since China currently has the largest number of populations in the world and is one of the fastest-growing aging populations in the world.43 In 2019, 254 million people in China were aged 60 years or older. By 2040, this number is expected to increase to 402 million, accounting for around 28 % of the population, due to longer life expectancy and declining fertility rates.44 This huge demographic shift will bring many new challenges for public health and socioeconomic development, and will present meaningful consequences for health services in China, with a rising burden of non-communicable diseases and a rising demand for health and social care systems.43 The impact of this aging pressure on health services would not only be faced by populous countries, including India (with the estimates of population of 1.09 billion in 2100), Nigeria (791 million), the United States (336 million), and Pakistan (248 million),43 but also would be faced by other countries with declined fertility rates. Globally, fertility rates declined in all countries and territories since 1950, and less than half of 204 countries and territories (46.1 %) had a total fertility rate above 2.1 (namely the replacement-level fertility) in 2021.45 Future fertility rates would continue to decline worldwide, with less than one-quarter of countries and territories with fertility rates remaining above replacement level in 2050 and only six (2.9 %) in 2100.45 How to turn these challenges brought by aging into opportunities for chronic disease (including cancer) management is an urgent problem faced by many countries ahead. These not only require the support from local health policies, but also urgently need to create innovative management models, such as mobile health and online health services, into the current health services for the elder population.

Nearly a half of lung cancer cases are diagnosed with distant metastases (United States vs. China: 48.2 % vs. 43.7 %),46 and these patients only have a 5-year survival rate <10 %.47,48 In contrast, patients diagnosed with localized lung cancer have a 5-year survival rate of ≥60 % globally.47,48 Thus, diagnosing lung cancer at an earlier stage is critical for improving prognosis. Randomized controlled trials (e.g., the United States National Lung Screening Trial and the NELSON study) had demonstrated that low-dose computed tomography (LDCT) screening can significantly shift lung cancer from late- to early-stage and substantially reduce deaths from lung cancer.49,50 A recent study from China has shown that one-off LDCT screening can also lower lung cancer mortality and all-cause mortality in countries with limited resources.51 Moreover, LDCT screening for high-risk individuals (current and former heavy smokers) can achieve more benefits when both early diagnosis and successful treatment are available.51 Despite well-established benefits of screening on lung cancer mortality observed in previous trials, the extension of screening benefits to the general population face several challenges, including radiation-related harms, patient anxieties due to non-high risk lung nodules, and unnecessary invasive procedures associated with false positives and overdiagnosis. The number of screening procedures needed to cause unnecessary harm was 59 and 62 in the NLST and NELSON trials,49,50 respectively. Moreover, the lack of costs and required infrastructure and low referral rates for additional assessments after positive LDCT also prohibit the attendance and coverage of LDCT screening, especially for countries and regions with limited resources. Hence, ongoing researches should attempt to stratify populations with a high risk of LDCT-detectable nodules with biomarkers and/or prediction models, which would reduce the risk of unnecessary harms associated with LDCT screening in the future. More importantly, comprehensive efforts should be integrated to remove the multiple barriers to LDCT-based lung cancer screening, including patient-related factors (lack of knowledge of screening benefits and fatalistic views about lung cancer), provider-related factors (limited awareness of screening guidelines and eligibility), and health-care system-related factors (lack of easy and fast links between screening records and existing electronic health records).

5. Limitations

Although this study provides a valuable global landscape of lung cancer burden, including the current status, temporal trend, and future projections, it is important to note that the current country-level lung cancer estimates are not intended as a substitute for the continuous monitoring data collected by high-quality, population-based cancer registries and vital registration systems. As shown in the temporal trend of lung cancer burden, high quality local data remain sparse in many countries, especially for transitioning countries. Therefore, the unavailability of high-quality data would unavoidably affect the robustness of the lung cancer estimates presented in these transitioning countries. Given the critical importance of building capacity for cancer prevention and control, initiative for cancer registry development must be further promoted to produce high quality local data for analysis, dissemination, and support for local decision making. Additionally, a lack of country-level information on smoking, other causes of lung cancer, and histopathological features limited further exploration of the link between different risk determinants and lung cancer subtypes (adenocarcinoma or squamous cell carcinoma).

6. Conclusions

Lung cancer is the leading cancer morbidity and mortality worldwide irrespective of the HDI level. The lung cancer burden is expected to increase in almost all of the UN regions, especially in countries with low and medium HDI levels. Increased lung cancer incidence will likely be paralleled with increased mortality, unless the growing number of cancer cases could be appropriately treated and managed when health resources are well placed. The increasing lung cancer burden associated with social and economic transition would also overwhelm health care systems in several low/medium HDI countries if no effective measures were taken to curb the current status. Finally, integrating current effective interventions (tobacco control, LDCT screening, and early treatment) with current health plans, and cultivating new interventions (risk-adapted management, AI-assistant screening, and precise targeted therapies) are urgently needed for the global prevention and control of lung cancer burden.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

Acknowledgments

We thank International Agency for Research on Cancer Registries for providing the qualified public database, and the local cancer registry staff who contributed to the cancer surveillance. This work was supported by the National Key Research and Development Program of China (grant number: 2021YFC2500400), Tianjin Health Committee Foundation (grant number: TJWJ2021MS008) and Tianjin Key Medical Discipline (Specialty) Construction Project (grant number: TYXZDXK-009A), Science and Technology Program of the Joint Fund of Scientific Research for the Public Hospitals of Inner Mongolia Academy of Medical Sciences (grant number: 2023GLLH0132), Scientific Research Fund for the Demonstration Project of Public Hospital Reform and Quality Development (Gastrointestinal Tumour) that is approved by Peking University Cancer Hospital (Inner Mongolia Campus) (grant number: 2023SGGZ068). The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Y.B.H. had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Y.B.H. and L.Y. designed the study. Y.T.J. and Y.M.Z. accessed and verified the data. Y.T.J., Y.M.Z., S.W.L., J.J.L., Q.Y.J., J.W., H.Y.D., X.M.L., Z.W.F., Y.L., Y.C.Z., Z.Y.L., L.Y., and Y.B.H. obtained, analyzed, or interpreted of data. Y.T..J, Y.MZ., and Y.B.H. prepared the draft of the manuscript. Z.Y.L., L.Y., and Y.B.H. critically revised of the manuscript for important intellectual content. All authors had full access to all the data in the study, approved the final version of the manuscript, and take final responsibility for the decision to submit it for publication.

Footnotes

Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.jncc.2025.01.003.

Contributor Information

Lei Yang, Email: younger2083@163.com.

Yubei Huang, Email: yubei_huang@163.com.

Appendix. Supplementary materials

mmc1.pdf (754.1KB, pdf)

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