Purpose <p>Real-world evidence (RWE) plays an increasingly important role in complementing randomized controlled trials (RCTs) in lung cancer research. This study aims to map the knowledge structure, identify research trends, and highlight future directions of real-world studies (RWS) in lung cancer through bibliometric analysis.</p> Methods <p>We retrieved publications on RWS in lung cancer from the Web of Science Core Collection (WOSCC) spanning 2009 to 2024. Bibliometric analyses were performed using CiteSpace, VOSviewer, and the R package Bibliometrix to examine publication trends, collaborative networks, co-citation patterns, and keyword bursts.</p> Results <p>A total of 2,137 articles were included. Annual publications increased markedly after 2017, accounting for 97.52% of the total. China contributed the most publications (<i>n</i> = 660), while the USA exhibited the highest centrality in international collaboration. Keyword burst detection identified “combination therapy,” “KRAS mutation,” and “deep learning” as the most current research frontiers.</p> Conclusions <p>This analysis underscores the pivotal role of RWE in complementing RCTs and validating therapeutic strategies in oncology. Current frontiers include combination therapy, KRAS mutations, and deep learning, indicating a shift toward precision oncology and advanced data analytics.</p>