Background: The survival of lung cancer patients in Hong Kong before and during the COVID-19 pandemic is poorly understood. Methods: Patients diagnosed with lung cancer from January 1 2010 to October 31 2022 were recruited from all 43 public hospitals in Hong Kong. Patients who died on the day of cancer diagnosis were excluded. Patients between 2020-2022 (pandemic) were matched with patients diagnosed between 2010-2019 (pre-pandemic) using 1:1 propensity score matching, based on demographics and comorbidities such as age, sex, and Charlson Comorbidity Index (CCI), to study survival before and during the pandemic. The outcomes were 1-year and 6-month all-cause mortality. In subgroup analysis, patients were categorized into 12 groups, from 2010 to 2022, based on the year of first diagnosis of lung cancer to investigate yearly changes in mortality. Patients with confirmed diagnosis of COVID-19 infection were also analyzed. Results: A total of 42102 lung cancer patients (66.0% male, age 72±12 years (median±SD), CCI 7.00±2.42) were recruited from 2010 to 2021 with 1-year follow up. Only 36 patients were confirmed COVID-19 positive. The matched cohort consisted of 4958 pandemic patients (68.6% male, age 72±12 years, CCI 8.00±2.43) and 4958 pre-pandemic patients (67.7% male, age 73±12 years, CCI 7.53±2.48). 2782 (56.1%) and 3846 (77.6%) pandemic patients died within 6 months and 1 year respectively, compared to 2338 (47.2%) and 3194 (64.4%) pre-pandemic patients. In subgroup analysis by year of lung cancer diagnosis, patients diagnosed in 2021 had highest risk of 1-year mortality (85.1%). There was no significant difference in mortality between patients with and without confirmed COVID-19 positivity. The cohort of 2022 lung cancer patients, with higher COVID-19 positivity, was still undergoing follow-up and will be included in the analysis at the time of presentation. Conclusions: Lung patients diagnosed during the COVID-19 pandemic are associated with higher risk of death within the first year compared to that of pre-pandemic patients, and is likely not associated with COVID-19 positivity.