A Czech national administrative real-world study of diagnostics and treatment pathways of non-small-cell lung cancer stratified by disease stage: From data to actionable indicators

Introduction The aim of this study was to develop and evaluate quality indicators (QIs) for the care of patients with non-small cell lung cancer (NSCLC). Methods This retrospective longitudinal cohort study covered the period 2017–2023, with follow-up until September 2025. Data were obtained from the National Cancer Registry (NCR) and the National Registry of Reimbursed Health Services (NRRHS), which integrates data from seven nationwide health insurance funds. The index date was defined as the first biopsy followed by histopathological examination with the ICD-10 code C34. Incident patients aged ≥ 18 years were included if no prior malignancy had been reported. Results Care pathways were analyzed in 15,886 patients with NSCLC. Of these, 3,380 (21.3%) were not treated and 1,837 (11.6%) were excluded due to the absence of (PET) CT before biopsy. The final cohort included 10,669 patients with a median age of 69 years (IQR 64–74). Stage distribution was: stage I–II 27.6%, stage III–IV 67.9%, and 4.5% unknown. MDT discussion was recorded in 53.9% of patients, with a median time to MDT review of 37 days. Surgery was performed in 81.0% of stage I and 68.4% of stage II patients. PD-L1 testing was documented in 70.0% of stage IV and 65.2% of stage III patients. Fewer than 50% of patients initiated treatment within 8 weeks regardless of stage. Centralization of care in Complex Oncology Centers and MDT implementation increased over time, although regional and stage-related disparities persisted. Conclusions Linkage of administrative claims with the NCR enabled stage-stratified monitoring of NSCLC care pathways and identification of actionable QIs, which were implemented as a national tool for continuous evaluation of cancer care quality in the Czech Republic.