Comparing The Clinical Features And Related Factors Affecting Pro- Gnosis Of Patients With Advanced Lung Cancer In Two Age Groups

Background and Objective: For the past few years,lung cancer has become the most common malignant tumor with the highest morbidity and mortality in the world.The high incidence age of lung cancer is between 50 and 75 years old.About 2/3 of the patients have been found to be in advanced stage and the 5-year survival rate is low.In recent years,the incidence of lung cancer among young people has shown an increasing trend.With the aging of the population,the proportion of lung cancer patients over 75 years of age has gradually increased.There is relatively little analysis of the survival of these two groups of people.In this study,we retrospectively analyzed the clinical characteristics,survival status,and prognosis of patients with advanced lung cancer in two age groups(?40 years old,?75 years old)and analyzed their prognostic factors to provide guidance on treatment.Methods: The clinical data and follow-up data of 34 patients with advanced lung cancer aged less than 40 years(group A)and 108 patients aged more than 75 years(group B)who were admitted to the First Affiliated Hospital of Soochow University from January2013 to December 2016 were collected.SPSS22.0 was used for statistical analysis to compare clinical features,pathological types and treatment methods.Univariate survival analysis was conducted using Kaplan-Meier analysis and COX regression analysis was performed to analyze the multivariate factors.Results:(1)Of the 142 patients with lung cancer,34 were in group A,the youngest being 25 years old,with an average age of 34.67 ± 4.38 years;in group B 108 patients,the oldest was 93 years old and the average age was 77.74 ± 3.15 years old.The female patients in group A(19/34)were significantly higher than those in group B(29/108),andthe difference was statistically significant(P<0.05).(2)The smoking rate in group A was 20.6%,and the smoking rate in group B was50.9%.Group B was higher than group A.There was a statistically significant difference between the two groups(P<0.01).Among them,the smoking rate of females in group A was 0.0%,and the smoking rate of females in group B was 1.9%.The smoking rates of males in both groups were higher than females.(3)Cough and sputum were the most common clinical manifestations in both groups.Symptoms of chest tightness in group B were higher than those in group A(P<0.01).(4)In group A,adenocarcinoma accounted for 85.3%,squamous cell carcinoma and small cell carcinoma each accounted for 5.9%.Adenocarcinoma in group B accounted for53.7%,squamous cell carcinoma accounted for 22.2%,small cell carcinoma accounted for19.5%.The proportion of adenocarcinoma was higher in group A than in group B(P<0.01).The proportion of squamous cell carcinoma and small cell lung cancer in group B was higher than that in group A,but there was no significant difference.(5)The rate of multi-organ metastasis was 61.8%(21/34)in group A and 33.3%(36/108)in group B.The rate in group A was significantly higher than that in group B.The difference between the two groups was statistically significant(P = 0.003).(6)Epidermal growth factor receptor(EGFR)gene mutation is the most common type of gene mutation in the two groups.The mutation rate of EGFR in group A was 44.4%(12/27),and the mutation rate in group B was 54.4%(24/44).There was no significant difference between the two groups.The incidence of microtubule-associated protein4-anaplastic lymphoma kinase(EML4-ALK)in group A was 33.3%(9/27),that in group B was 2.3%(1/44),and that in group A was significantly higher than that in group B(P<0.01).(7)The majority of patients in group A received multiple treatments.The median survival time was 23.5 months in group A,which was significantly higher than that of group B(11 months)(P<0.01).Among group A,the median survival time of patients with brain metastasis was significantly shorter than the patients without brain metastasis(12.5vs 40.7 months),the difference was statistically significant(P=0.013).Gender,anti-tumor therapy history,PS score and pathological type were independent factors influencing the prognosis in group B.PS score were independent influencing factors for the prognosis of the two groups.Conclusions: The incidence of female,adenocarcinoma and distant organ metastasis in group A was high.The overall survival of group A was significantly longer than that of group B.PS score was an independent factor in the prognosis of group A;gender,pathological type,PS score and anticancer treatment were independent factors in the prognosis of group B.