| Objective:To analysis the clinicopathologic features and survival of lung cancer patients under 40 years of age at diagnosis and to assess the differences in those between patients under 40 years of age and older patients. Method:Retrospective review of a total of 129 young patients with primary bronchogenic carcinoma diagnosed at The Second Affiliated Hospital of Zhejiang University from 2000 to 2008. Data regarding demographics, histology, initial therapy, and survival were obtained. Results: 129 cases of lung cancer patients under 40 years of age or just 40 years old with pathological confirmation had been registered in our hospital from 2000 to 2008. A rising trend was observed in the number of newly diagnosed cases each year. In this group, the age of all 129 patients ranged from 20 years to 40 years, with a median age of 37 years.56 patients (43.4%) were less than 35 years old, and 73 patients (56.6%) were 36-40 years old. Of the 129 patients,76 were male and 53 were female. Propotion with regard to gender was 1.43:1 (men:women). The main clinical symptoms include cough,haemoptysis,chest pain,chest distress and fever. Cough was the most common symptom and happened in 60 cases (46.5%). Haemoptysis and chest pain were also frequent and observed in 21 patients (16.3%). And a few patients was admitted with chest distress or fever as chief complaint (11 or 2,8.5% or 1.5%). However there were part of patients (21,16.3%) admitted to the hospital with headache,backache or neck pain that had nothing related to respiratory system, and 14 patients (10.8%) presented no symptoms. Period between the time the symptoms emerged to the time the patients were admitted to hospital ranged from 4 days to 3 years, with the mean value about 2.6 months.38 out of 129 patients had tobacco use, and 37 were male. The rest 91 nonsmokers included 39 men and 52 women. The percentage of smokers among male patients in comparison to female ones was much higher, and the difference had reached the statistical significance (48.7% vs.1.9%, P＜0.05). Adenocarcinoma was the most common type in both smokers or nonsmokers groups,17 patients (44.7%) and 62 patients (68.1%) respectively. And in both groups,9 and 13 patients with small cell lung cancer were observed respectively (23.7% and 14.3% respectively). The incidence adenocarcinoma, small cell and squamous cell in smoker or nonsmoker groups had statistical significant different. And to be precise, the incidence of adenocarcinoma was 44.7% vs. 68.1% (P＜0.05), small cell was 23.7% vs.14.3% (P＜0.05), adenosquanous carcinoma was 23.7% vs.13.2% (P＜0.05). The sites of metastasis conclude bone(in 37 cases), brain(in 16 cases), eye(in 2 cases). Of all 129 cases,114 (88.3%) were stageⅢA-Ⅳ.35 patients (27.1%) were treated by surgery and 45 patients (34.9%) were treated by chemotherapy. Combined modality treatment was applied to 21 patients (16.3%), only 3 patient (2.3%) received radiotherapy,25 patients(19.4%) gave up or choosed only symptomatic treatment. By definition, suvival was span from the first diagnosed as lung cancer to patients death or the last visit. The mean suvival of all 129 patients was 3 months, and 1 patient suvival for 3 years which was to be the longest. Conclusions:Lung cancer in young patients occurs most frequently in patients between 30 to 40 years of age, and was rarely seen before 30 years old. Men were still the major population in young patients with lung cancer as were in older ones. Adenocarcinoma and small cell carcinoma were the most common types in young patients. Metastasis was frequent and resulted in worse prognosis. However, young patients were treated more aggressively and were more likely to undergo surgery therapy. The clinical features of lung cancer showed no special and were frequently neglected in young patients, resulting misdiagnosis frequently.
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