Lung cancer in syria: a retrospective study for clinical profiling and stage/smoking analysis

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Abstract

Background: Lung cancer is the leading cause of cancer mortality worldwide. While high-income countries have generated extensive epidemiological data, evidence from low- and middle-income nations—especially those affected by conflict—remains limited. We sought to describe the clinicopathological profile of lung cancer in Syria and to explore whether smoking history influences stage at diagnosis. Methods: We performed a retrospective review of all patients with histologically confirmed primary lung cancer seen at Al-Bayroni University Hospital, the Syrian national cancer center, from 2022 to 2024. Clinical variables included age, sex, smoking status, histological subtype, and TNM summary stage. Histologies were grouped into standard categories. Descriptive statistics were calculated, and associations between smoking and stage were evaluated using chi-square testing. Results: A total of 3,028 patients were identified. The mean age was 60.7 years (SD 15.5), and men predominated (84%). Most patients reported a smoking history (82%; 61% current, 21% former). Adenocarcinoma accounted for nearly half of cases (45.5%), followed by small cell carcinoma (21.6%) and squamous carcinoma (17.5%). Large cell (0.8%) and neuroendocrine tumors (1.0%) were rare, while other histologies comprised 13.6%. Late presentation was the rule: more than two-thirds were diagnosed at stage III or IV, with adenocarcinoma showing the highest proportion of stage IV disease (~ 77%). No meaningful association was found between smoking status and stage at diagnosis (p > 0.05 across subtypes). Conclusion: Lung cancer in Syria is marked by heavy male predominance, high smoking prevalence, a shift toward adenocarcinoma, and advanced presentation regardless of smoking. Strengthening diagnostic access and tobacco control should be priorities for reducing the national burden.

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