Abstract
Background
The diagnosis and treatment of non-small cell lung cancer (NSCLC) has made rapid progress. Cancer survivors with prolonged survival time are also susceptible to non-cancer diseases. The study aims to identify the causes of death in NSCLC for improved management and survival.
Methods
Data were extracted from National Cancer Institute’s Surveillance, Epidemiology, and End Results program (2000–2021). Cumulative incidence of mortality in NSCLC patients, considering both lung cancer-related and other causes, were calculated using the competing-risks regression model. The trend in annual age-standardized mortality rate from various causes of death in NSCLC was described by the joinpoint regression model. The distributions of the leading 10 non-cancer causes of death in NSCLC were reported via stacked area charts and bar charts. Moreover, subgroup analyses based on tumor stage, age, and pathological type were conducted.
Results
Among all 768,309 patients with NSCLC, mortality from lung cancer accounted for approximately 76.4% deaths (479,520/627,976). However, the proportion of deaths attributable to lung cancer gradually decreased over time, although it remained the predominant cause of death. The cumulative incidence of mortality from lung cancer ranged from 52% to 69% from 24 to 144 months after diagnosis, while that of mortality from other causes ranged from 12% to 27%. Moreover, there was a larger-magnitude decrease in the annual mortality from lung cancer than other causes (average annual percent change [AAPC] − 4.38% (− 5.65 to − 3.00%) vs. − 2.43% (− 3.69 to − 0.93%)), and the proportion of deaths from other causes increased from 16.18% to 35.34%. The change was particularly evident among the elderly (AAPC-lung cancer: −5.21% (− 5.72 to − 4.75%); AAPC-other causes: 0.60% (0.14 to 1.01%)) and those in stage I and in situ (AAPC-lung cancer: −8.42% (− 10.14 to − 6.54%); AAPC-other causes: 3.93% (0.60 to 10.57%)). Diseases of heart, chronic obstructive pulmonary disease and various infections were relatively more prevalent in non-cancer deaths.
Conclusion
NSCLC is a complex disease with multiple factors involved, and the therapeutic alternatives have significantly increased. While lung cancer-related death remains the primary cause, the proportion of non-lung cancer-related death has increased, which requires attention.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12889-026-27405-1.
Keywords: Mortality, Cause of death, Trend, Cumulative incidence, Age-standardized rate, NSCLC, SEER
Introduction
According to recent data published by the International Agency for Research on Cancer (IARC), there were 20 million new cancer cases and 9.7 million cancer-related deaths globally in 2022, and the global incidence of new cancer cases will exceed 35 million by 2050, indicating a staggering increase of 77% [1]. Lung cancer, the most prevalent malignancy worldwide, stood as the primary contributor to cancer-related mortality, constituting 18.7% of all cancer deaths [2]. The predominant subtype was non-small cell lung cancer (NSCLC), accounting for approximately 85% of all lung cancer diagnoses [3]. The management of NSCLC has progressively advanced in recent years, with targeted therapy and immunotherapy enabling more patients to achieve prolonged survival [4, 5]. It was reported that a metastatic NSCLC patient with epidermal growth factor receptor tandem kinase domain duplication mutation had a greater than 10-year response to targeted therapy and lived for more than 20 years [6]. Cancer survivors with prolonged survival time are also susceptible to non-cancer diseases, such as diseases of heart, chronic obstructive pulmonary disease (COPD) and severe infections [7]. Lung cancer and COPD shared common risk factors and frequently coexisted [8, 9]. Worsening airflow obstruction increased the risk of developing lung cancer, but mortality was more commonly caused by respiratory-related comorbidities and cardiopulmonary failures [10]. Furthermore, there was also a two-way association between lung cancer and cardiovascular disease. Cardiovascular disease increases the risk of developing NSCLC, and NSCLC, especially adenocarcinoma, was associated with a higher risk of cardiovascular disease [11].
NSCLC is a complex disease with multiple factors involved. Hence, it is imperative to investigate the causes and distribution patterns of mortality in NSCLC, and develop tailored follow-up strategies to optimize overall survival outcomes. The objective of the study is to describe the causes of death among patients with NSCLC via the following parts (i) cumulative incidence of mortality from lung cancer and other causes, (ii) trends in annual mortality from lung cancer and other causes, and (iii) the distribution of the leading non-cancer causes of death in NSCLC. Additionally, subgroup analyses based on tumor stage, age, and pathological type were conducted in all parts.
Materials and methods
Data sources
Data were extracted from National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program using SEER*Stat software by signing the corresponding agreement on the official website. SEER is a comprehensive cancer surveillance network that systematically gathers data on cancer incidence and survival rates across diverse geographic regions in the United States. The study utilized the SEER 17 database, which encompasses 17 registries and covers approximately 26.5% of the U.S. population. The database was based on the November 2023 submission (2000–2021) and released in April 2024 [12]. This study enrolled patients across all stages of NSCLC, characterized the distribution and temporal trends of causes of death, and further analyzed the distribution of non-cancer-related causes of death. The longest follow-up time in the survival analysis was 263 months, and the median follow-up time was 11 months. Mortality estimates were derived using the number of individuals at risk in each calendar year. Data collected from the SEER database are anonymized and de-identified. Therefore, no further ethical approval or consent is required.
Study cohort
The retrospective study consisted of three primary parts, including patients with NSCLC between 2000 and 2021 (flowchart in Supplementary Fig. 1). Subjects with NSCLC were defined based on SEER ICD-O-3 site recode (C340-C349) and histology coding clarifications [13, 14]. Tumor stage was defined using SEER-derived staging variables, which are based on successive AJCC TNM staging systems. Specifically, AJCC stage 3rd edition was used for 2000–2003, Derived AJCC Stage Group (6th edition) for 2004–2009, Derived AJCC Stage Group (7th edition) for 2010–2015, Derived SEER Combined Stage Group for 2016–2017, and Derived EOD 2018 Stage Group (aligned with AJCC 8th edition) for 2018–2021. To ensure comparability across diagnosis years, these variables were harmonized into four broader categories: Stage I and in situ group, Stage II group, Stage III group, and Stage IV group. To ensure a comprehensive and medically significant characterization of causes leading to mortality in NSCLC, all subjects were included except for those exclusively determined through autopsy or death certificate.
Statistical methods
The clinical characteristics, including age, tumor stage, and pathological type, as well as the outcomes of all subjects, were summarized in the table. Additionally, a comparison of clinical characteristics was conducted between groups based on causes of death (lung cancer and other causes). The non-normally distributed continuous variable (age) was presented as median (Q1, Q3), while categorical variables (tumor stage, pathological type, and outcome) were presented as frequency (n) and proportion (%). Non-normally distributed continuous variables were analyzed using the Mann-Whitney U test, whereas categorical variables were assessed using the chi-square test.
For objective I, cumulative incidence of mortality from lung cancer and other causes in NSCLC were calculated using a competing-risks regression model with the application of cumulative incidence function, considering the presence of competing risk [15, 16]. For Objective II, the strategy used to calculate annual age-standardized mortality (ASR) estimates for NSCLC is presented in Supplementary Fig. 2. The denominator was defined as the population at risk in each calendar year, including both individuals who survived from previous years and newly diagnosed cases in that year. Mortality in NSCLC cohort was calculated for each age group, weighted by the standard population distribution, and summed to derive the ASR estimates. And the ASR calculation was based on the World Health Organization’s World Standard Population (2000–2025) [17, 18]. These estimates were based on the number of individuals at risk rather than person-time and therefore reflect annual mortality probabilities within the NSCLC cohort. The joinpoint regression model was employed to examine the trend in annual mortality and determine annual percent change (APC) and average annual percent changes (AAPC) [19]. For objective III, the distribution of the leading 10 causes of non-cancer death were described via stacked area charts and bar charts. Moreover, subgroup analyses based on tumor stage (classified as stage I and situ, stage II, stage III, and stage IV), age (classified as Age 0–49, 50–59, 60–69, and 70–79, and 80+), and pathological type (classified as adenocarcinoma, squamous cell carcinoma, large cell carcinoma, and not otherwise specific) were performed.
The statistical analyses were performed using SEER*Stat software (version 8.4.3), R software (version 4.2.1) and Joinpoint Regression Program (version 5.0.2). Statistical significance was determined at a two-sided P-value threshold of < 0.05.
Results
Characteristics of subjects
The study included a total of 768,309 patients diagnosed with NSCLC from 2000 to 2021. The maximum follow-up duration reached 263 months and the median follow-up was 11 months. The age, tumor stage, pathological type, and outcomes of all subjects were presented in Supplementary Table 1. Among all un-survival cases (n = 627,976), 76.4% cases (479,520/627,976) died from lung cancer itself, while 23.6% cases (148,456/627,976) died from other causes, including cardiovascular events, COPD, severe infections, and other non-cancer cause, as well as a second primary malignant tumor. As shown in Table 1, in comparison to patients who died of lung cancer itself, those who died of other causes exhibited a higher median age, were more likely to be in the early and intermediate-stage, demonstrated a relatively longer survival time, and displayed significant differences in pathological subtypes.
Table 1.
Characteristics of subjects with varying causes of death
| Overall | Lung cancer | Other causes | P-value | |
|---|---|---|---|---|
| n | 627,976 | 479,520 | 148,456 | |
| Age (median [IQR]) | 71.00 [63.00, 78.00] | 70.00 [62.00, 77.00] | 72.00 [65.00, 78.00] | < 0.001 |
| Tumor stage (%) | ||||
| Stage I and situ | 107,327 (18.8) | 55,602 (12.7) | 51,725 (39.0) | < 0.001 |
| Stage II | 34,612 (6.1) | 23,845 (5.4) | 10,767 (8.1) | |
| Stage III | 140,636 (24.6) | 113,186 (25.8) | 27,450 (20.7) | |
| Stage IV | 288,811 (50.5) | 246,217 (56.1) | 42,594 (32.1) | |
| Histology (%) | ||||
| Adenocarcinoma | 312,512 (49.8) | 240,047 (50.1) | 72,465 (48.8) | < 0.001 |
| Squamous cell carcinoma | 174,027 (27.7) | 129,144 (26.9) | 44,883 (30.2) | |
| Large cell carcinoma | 20,699 (3.3) | 16,348 (3.4) | 4351 (2.9) | |
| Not otherwise specified | 120,738 (19.2) | 93,981 (19.6) | 26,757 (18.0) | |
| Survival time (median [IQR]) | 8.00 [2.00, 24.00] | 7.00 [2.00, 19.00] | 17.00 [4.00, 54.00] | < 0.001 |
IQR Interquartile range
Cumulative incidence of deaths over the follow-up period
The cumulative incidence of mortality from lung cancer and other causes during follow-up was illustrated in Fig. 1, while Supplementary Table 2 provided specific values. Among all 768,309 NSCLC patients, the cumulative incidence of mortality from lung cancer ranged from 52% to 69% from 24 to 144 months after diagnosis, while that of mortality from other causes ranged from 12% to 27%. The cumulative incidence of mortality from lung cancer showed a significant increase in the early follow-up period, but then slowed down after approximately 48 months. Furthermore, the cumulative incidence of mortality from other causes has exhibited a more rapid increase compared to that of mortality from lung cancer itself since 24 months after diagnosis (Fig. 1A).
Fig. 1.
Cumulative incidence of mortality from lung cancer and other causes in total non-small cell lung cancer (A), tumor stage subgroups (B), age subgroups (C), and pathological type subgroups (D); Distribution of causes of death during among patients with varying survival times (E)
Subgroup analysis based on tumor stage revealed that in stage I and situ, the cumulative incidence of mortality from other causes exceeded that of mortality from lung cancer after 144 months. Besides, with advancing tumor stage, there was an increasing gap in the cumulative incidence between these two types of death (Fig. 1B). Subgroup analysis based on age indicated a higher cumulative incidence of mortality from other causes among older NSCLC patients, which can reach up to 20% within 10 years among those aged 60 to 69 and earlier among those aged 70 and above (Fig. 1C). Additionally, there are differences between pathological types, with a higher cumulative incidence of mortality from lung cancer in large cell type, and a higher cumulative incidence of mortality from other causes in squamous cell carcinoma (Fig. 1D).
On the whole, as the survival time prolonged, there was a rise in the proportion of deaths from non-lung cancer-related causes, especially among the elderly and patients in stage I and situ. Notably, individuals who survived for more than 4 years exhibited a higher proportion of non-lung cancer-related deaths (Fig. 1E).
Trends in annual mortality
The Supplementary Tables 3–6 presented the annual ASR for mortality among total subjects and subgroups stratified by tumor stage, age, and pathological type from 2000 to 2021. Across calendar years, deaths from lung cancer accounted for the majority of deaths and gradually decreased over time, ranging from 83.82% in earlier years to 64.66% in later years. The proportion of deaths from other causes increased from 16.18% to 35.34%. Additionally, Supplementary Table 7 presented the trends in ASR for mortality with the values of AAPC and APC using joinpoint regression analysis, while Fig. 2 provided a visual presentation of these trends. Whether in total subjects or subgroups, the decline in mortality from lung cancer were more significant than those from other causes of death. In all cases of NSCLC, the ASR for mortality from lung cancer declined from 2000 to 2021 with an AAPC [95% confidence interval (CI)] of − 4.38% (− 5.65 to − 3.00%), which was more significant than that from other causes (AAPC = − 2.43%, 95% CI: −3.69 to − 0.93%) (Fig. 2A).
Fig. 2.
Trends in age-standardized rate for mortality from 2000 to 2021 in total non-small cell lung cancer (A), tumor stage subgroups (B), age subgroups (C), and pathological type subgroups (D); Trends in the distribution of causes of deaths from 2000 to 2021 (E)
According to the subgroup analysis based on tumor stage presented in Fig. 2B, we observed a more obvious gap between mortality from lung cancer and other causes in advanced-stage NSCLC. However, the gaps between mortality from the two causes all have been progressively narrowing in different tumor stages with a significant decline in mortality from lung cancer. And patients in stage I and situ had the smallest gap due to the most significant downward trend in the mortality from lung cancer (AAPC = − 8.42%, 95% CI: −10.14 to − 6.54%) and an upward trend in the mortality from other causes (AAPC = 3.93%, 95% CI: 0.60 to 10.57%). Besides, patients aged 80 and over demonstrated a modest increase in mortality from other causes (AAPC = 0.60%; 95% CI: 0.14 to 1.01%), but a substantial decline in mortality from lung cancer (AAPC = − 5.21%; 95% CI: −5.72 to − 4.75%) (Supplementary Table 7). Subgroup analysis based on age revealed that while the mortality from lung cancer was obviously higher for patients aged 50 and over in NSCLC, it has exhibited a more pronounced decline with relatively stable trends in mortality from other causes (Fig. 2C). Differently, the mortality from other causes among patients under 50 has exhibited a consistent decline, which was slight faster than that from lung cancer (AAPC − 4.13% vs. − 4.10%) (Supplementary Table 7). Nevertheless, owing to the higher baseline mortality from lung cancer, the gaps in mortality between the two causes all have been narrowing in all age subgroups. Apart from squamous cell carcinoma, there have been significant decline in mortality from lung cancer in other pathological types. And the mortality from other causes in adenocarcinoma and non-specific type have also witnessed a relatively modest decline (Fig. 2D; Supplementary Table 7).
As shown in Fig. 2E, the proportion of deaths from other causes significantly increased from 19.50% to 27.45% from 2000 to 2021 with an AAPC (95% CI) of 2.34% (0.92 to 4.40%) (Supplementary Table 7), which was due to a more significant decline in annual mortality from lung cancer. Overall, the gap in annual mortality between the two causes was observed to be narrowing, particularly among the elderly and patients in stage I and situ.
The leading non-cancer causes of death in NSCLC
There were 148,456 deaths due to non-lung cancer-related causes, including non-cancer causes and other malignant tumors. The distribution of the leading 10 causes of non-cancer death in NSCLC across calendar year and survival time subgroups was displayed in Supplementary Fig. 3, while Supplementary Tables 8–9 presents the precise population and proportions of these causes among non-lung cancer related deaths. Most of the non-cancer deaths were caused by diseases of heart and COPD, which accounted for 18.8% (27,919/148,456) and 13.1% (19,387/148,456) of non-lung cancer related deaths respectively.
Each non-cancer cause demonstrated distinct distributions in subgroups. Figure 3A and Supplementary Table 10 reveals the rate of non-cancer causes in non-lung cancer-related deaths across different tumor stages. In addition to suicide and self-inflicted injury, as well as other infections and parasites including human immunodeficiency virus (HIV), which exhibited a higher prevalence in advanced-stage, the remaining non-cancer causes were more common in the early and middle stages. In each tumor stage, diseases of heart and COPD were the primary causes of non-cancer deaths, while cerebrovascular diseases, pneumonia and influenza, along with accidents and adverse effects ranked among the top 3 to 5 (Fig. 3B). Additionally, there were variations observed in the rates across different age subgroups for each non-cancer cause. Accidents and adverse effects, suicide and self-inflicted injury, along with other infections and parasites including HIV, exhibited higher prevalence among younger patients (age < 50). Conversely, other causes, including diseases of heart, COPD and cerebrovascular diseases, were more prevalent among the older patients (age ≥ 50) (Fig. 4A; Supplementary Table 11). Similarly, diseases of heart remained the primary cause of non-cancer deaths across all age groups. However, other infections and parasites including HIV were relatively more prevalent than COPD (217/4,247 vs. 197/4,247) in the younger group (age < 50) (Fig. 4B). In contrast to tumor stage and age subgroups, the rate of non-cancer death in various pathological types exhibited a relatively balanced distribution (Fig. 5A; Supplementary Table 12). And diseases of heart and COPD remained the most prevalent causes across different pathological subgroups (Fig. 5B).
Fig. 3.
(A) The rate of leading causes of non-cancer deaths binned by tumor stage; (B) The distribution of leading causes of non-cancer deaths in tumor stage subgroups
Fig. 4.
(A) The rate of leading causes of non-cancer deaths binned by age; (B) The distribution of leading causes of non-cancer deaths in age subgroups
Fig. 5.
(A) The rate of leading causes of non-cancer deaths binned by pathological type; (B) The distribution of leading causes of non-cancer deaths in pathological type subgroups
Discussion
Despite the confirmed survival benefits of targeted therapy and immunotherapy [20], the mortality in NSCLC remains alarmingly high worldwide [2]. It has been reported that, with increasing follow-up time, the impact of cardiovascular disease, COPD, and other non-cancer causes on mortality in NSCLC gradually escalated [21, 22]. Previous studies have also reported a higher risk of cardiovascular events in NSCLC, related to both treatment-related factors and general risk factors [23, 24]. The study stands out for its inclusion of patients at all stages of NSCLC, as well as its description of the patterns of causes of death, along with the analysis of the distribution of the leading non-cancer causes. Therefore, the current work is collaborative to previous studies and represents a relatively comprehensive study in this field. The factors contributing to cancer mortality are complex, including functional disturbances in multiple interconnected physiological systems [25]. The analysis of trends in causes of death may indicate the management priorities for different stages in NSCLC.
Lung cancer-related mortality remained the primary cause of death for the NSCLC patients. The risk of non-lung cancer-related mortality in NSCLC significantly increased with prolonged survival, particularly in patients with early tumor stage and the elderly. Secondly, the annual ASR for mortality from lung cancer and other causes both exhibited a declining trend, with a more pronounced decrease observed in the mortality from lung cancer. The gap in mortality between the two causes was observed to be narrowing, particularly among the elderly and those in stage I and situ. These trends may, in part, be attributable to advances in targeted therapies and immunotherapy, especially in patients with adenocarcinoma, which have substantially improved overall survival. Furthermore, we also presented the distribution of the top 10 non-cancer causes of mortality across various subgroups. Among these, diseases of heart and COPD were relatively more prevalent, while other infectious diseases and parasites including HIV were also more prevalent in the younger subgroup (age < 50). Moreover, there also existed differences in the distribution of mortality among different pathological types owing to the differences in malignancy level, susceptibility factors and treatment development. The large cell type exhibited a higher cumulative incidence of mortality from lung cancer, while squamous cell carcinoma showed a higher cumulative incidence of death from other causes. And there were significant decreasing trends in mortality due to the two causes in the adenocarcinoma. These patterns likely reflect substantial differences in clinical characteristics and therapeutic advances across histological subtypes. Patients with adenocarcinoma have benefited from targeted therapies and immunotherapy, resulting in improved survival. In contrast, squamous cell carcinoma, which is strongly associated with smoking exposure and comorbidities such as COPD, carries a higher risk of respiratory and other non-cancer–related deaths. Therefore, accounting for histological subtype is essential when interpreting cause-specific mortality in NSCLC.
There were many non-cancer deaths in NSCLC. The most prevalent were diseases of heart, COPD and infections. These diseases also exhibit the highest mortality worldwide [26], and their incidence and progression are intricately linked to the tumor state.
The potential cardiotoxicity from chemotherapy based on platinum [27], targeted therapy [28], and immunotherapy [29] all have been reported, which is more pronounced in patients with pre-existing cardiovascular disease risk factors. Besides, diseases of heart and NSCLC share common risk factors (such as old age, smoking, environmental exposure) and pathophysiological mechanisms (such as inflammation and oxidative stress) [30]. Similarly, the occurrence and development of lung cancer and COPD involve multiple factors and may share the same pathophysiological mechanisms, such as oxidative stress, chronic inflammation, aging, telomere shortening, epithelial-mesenchymal transition, genetic susceptibility, and epigenetic changes [31]. These also explain that deaths due to non-lung cancer-related causes were more prevalent among the elderly patients and those in stage I and situ for the longer survival, ageing and more risk factors.
Furthermore, the destruction of hematopoiesis and immunosuppression caused by tumor cells and tumor microenvironment [32], the blockage of the airway caused by the tumor itself [33], and the decreased respiratory ventilation and atelectasis due to physical inactivity [34] all contribute to increased susceptibility to pathogens. Furthermore, the destruction of mucosal barriers and myelosuppression caused by chemotherapy and radiotherapy are also included. These factors increase the susceptibility to opportunistic viral, fungal, and parasitic infections that are typically mild in healthy individuals but can result in life-threatening complications for those with cancer. A typical example reported is the heightened risk of COVID-19 mortality faced by cancer patients in comparison to the general population [35]. The characteristics of the pathogen may be the reason why the distribution of specific causes of death differs among different subgroups. The distribution of specific causes of death among different subgroups may be attributed to the distinct characteristics of pathogens; for instance, mortality due to pneumonia and influenza was more prevalent in the elderly, whereas mortality due to parasites and HIV was higher among younger individuals.
The analysis has important limitations. As an observational study, the wide range of diagnosis years among the study subjects and variations in the starting point of follow-up time may impact the generalizability of the results. Deaths due to other causes may be miscoded due to confusion between newly diagnosed cancers and localized recurrences in adjacent organs. Besides, the retrospective study underscores the need for further prospective research to validate and establish predictive models and nomograms with high prediction accuracy and resolution for specific causes of mortality.
Conclusion
Although the lung cancer-related death remained the primary cause in NSCLC, non-lung cancer-related deaths have become increasingly significant. The cumulative incidence of mortality from non-lung cancer-related causes has increased more rapidly over time. There has also been a significant increase in the proportion of deaths from non-lung cancer-related causes, particularly among the elderly patients and those in stage I and situ. Diseases of heart, chronic obstructive pulmonary disease and various infections were relatively more prevalent in non-cancer deaths, requiring more attention for long-term management of NSCLC patients. Our findings may encourage further investigation into comorbidities associated with NSCLC to enhance patient management and survival outcomes.
Supplementary Information
Acknowledgements
The authors would like to thank the efforts of the National Cancer Institute and the Surveillance, Epidemiology, and End Results (SEER) Program tumor registries in the creation of the SEER database.
Abbreviations
- ASR
Age-scandalized rate
- APC
Annual percent change
- AAPC
Average annual percent change
- CI
Confidence interval
- COPD
Chronic obstructive pulmonary disease
- HIV
Human immunodeficiency virus
- IARC
International Agency for Research on Cancer
- NSCLC
Non-small cell lung cancer
- SEER
Surveillance, Epidemiology, and End Results
Authors’ contributions
Xinyu Wang (First Author): Conceptualization, Methodology, Software, Investigation, Formal Analysis, Writing - Original Draft; Chao Sun, Yajie Lu, and Binchan He: Data Curation, Writing - Original Draft; Tingting Zhao and Yin Liu: Investigation, Writing - Review & EditingXin Su (Corresponding Author): Conceptualization, Funding Acquisition, Resources, Supervision, Writing - Review & Editing.
Funding
This work was supported by the National Science and Technology Major Project (2024ZD0522506), Project of Natural Science Foundation of China (82570016), Leading-edge Technology Research and Development Program of Jiangsu Province (BF2025625), and General Program of Clinical Research, Nanjing Drum Tower Hospital (2023-LCYJ-MS-18).
Data availability
The data that support the findings of this study are openly available in the Surveillance, Epidemiology, and End Results (SEER) Program at https://seer.cancer.gov/.
Declarations
Ethics approval and consent to participate
This study used anonymized and de-identified data previously collected from the Surveillance, Epidemiology, and End Results (SEER) database. Therefore, no additional ethical approval or consent is required.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The data that support the findings of this study are openly available in the Surveillance, Epidemiology, and End Results (SEER) Program at https://seer.cancer.gov/.