Global burden of lung cancer from 2000 to 2023 and projections to 2035: Implications for ctDNA-based molecular residual disease–guided care.

Abstract

e22519 Background: Lung cancer remains a leading cause of cancer-related morbidity and mortality worldwide, with non-small cell lung cancer (NSCLC) accounting for approximately 85% of cases. Circulating tumor DNA (ctDNA)–based molecular residual disease (MRD) assays are increasingly studied in NSCLC to enable earlier detection of recurrence and guide perioperative and adjuvant treatment strategies. However, the relevance of MRD-guided approaches has not been contextualized within long-term global lung cancer burden trends. We evaluated temporal patterns in lung cancer burden from 2000–2023, projected trends through 2035, and explored implications for MRD implementation. Methods: Global Burden of Disease (GBD) 2000–2023 estimates were analyzed for tracheal, bronchus, and lung (TBL) cancer incidence, mortality, and disability-adjusted life years (DALYs). Age-standardized rates (ASRs) per 10,000 population were extracted overall and stratified by sex and sociodemographic index (SDI). Trend-based projection models were applied to observed ASRs to estimate burden through 2035. Analyses were descriptive, and implications for MRD-guided care were hypothesis-generating. Results: In 2023, global ASRs per 10,000 were 26.94 for incidence, 18.78 for mortality, and 568.80 for DALYs. Burden was higher in males than females for incidence (39.76 vs 16.06), mortality (36.53 vs 14.07), and DALYs (840.20 vs 327.39). High-SDI regions exhibited the highest incidence ASR (37.13) and DALYs ASR (755.10). Projections suggest persistent lung cancer burden through 2035, with the greatest burden in males and high-SDI settings. Conclusions: Global lung cancer burden remains substantial and is projected to persist through 2035, with marked disparities by sex and sociodemographic development. Although GBD does not distinguish histologic subtypes or capture treatment pathways, observed trends are likely driven predominantly by NSCLC. High-SDI regions—where perioperative systemic therapy and longitudinal surveillance are established—may represent priority settings to evaluate ctDNA-based MRD strategies. These findings provide a population-level framework to contextualize emerging molecularly guided approaches.