Trend Analysis And Clinicopathological Characteristics Of Young Patients With Lung Adenocarcinoma

Objective:The aim of the study is to analyse the trend of incidence,the clinical characteristics and therapy of young(less than 40 years old)lung adenocarcinoma patients,identify prognostic factors.Method:The clinical date of 260 young lung adenocarcinoma patients were collected from Cancer hospital and institution of Chinese academy of medical science from January 2001 to June 2012 retrospectivly.To analyse the trend of incidence,the clinical characteristics and therapy for them and evaluate the independent prognostic factors which affected the survival time.with COX proportional hazards model.Result:1.trend analysis and clinicopathological characteristicsFrom 2001 to 2012,the incidence increased year by year.Among 260 patients with lung adenocarcinoma,132 were male and 128 were female.The male-to-female ratio was 1.32:1.The age was from 20 to 40 and the median age was 35 years old.Among 260 patients,TNM stage was presented in the following:stage I 46 cases(17.7%),stage ? 19 cases(7.3%),stage III A 32 cases(12.3%),stage III B 24 cases(9.2%),and stage IV 139 cases(53.5%).The 1 year,3year,5 year survival rates were 70.7%.21.6%.10.3%.2.Tumor differentiation.tumor marker.gene testing of the EGFR/ALK/K-rasTumor differentiation was mostly poor((low differentiation accounted for 58.0%,moderate differentiation 31.5%).The tumor marker of CEA and CA125 were detected in all patients.Among them,the CEA of 95 cases were abnormal(36.5%)and the CA125 of 88 cases were abnormol(33.8%).65 patients received EGFR gene testing and 34 cases showed EGFR gene mutation(52.3%);61 patients received K-ras gene testing and 7 cases showed gene mutation(11.5%);20 patients received EML4-ALK fusion gene testing and 8 cases showed postive(40%).3.Analysis of the operation situation and the effect of chemotherapy and targeted therapyAmong 97 patients of stage ???A,99%(96/97 cases)patients underwent complete surgery.Among 35 cases of recurrence and 163 cases of stage ?B??,the PFS who received first-line chemotherapy with pemetrexed and platinum was significantly longer than paclitaxel plus platinum(PFS were 13.0 and 5.0 months,P ?0.031).Among above 198 cases,patients who have received the epidermal growth factor receptor-tyrosine kinase inhibitors(EGFR-TKI)therapy,the median OS was significantly longer than that who never received EGFR-TKI therapy(median OS was 25.6 months and 13.3 months,P<0.001).After 2009 EGFR gene detection rate gradually increased.The median OS of patients diognosed from 2010 to 2012 was 22 months compared to 16 months of patients diognosed from 2006 to 2009.The difference was statistically significant(P=0.019).4.survival and prognosis analysisCox regression analysis of 260 patients showed that the age?PS?TNM stage were the independent factors(P<0.05).Cox regression analysis of the patients of stage???A showed that the age(P=0.016).lymph node metastasis(P=0.014).TNM stage(P<0.001)were the independent factors.Cox regression analysis of the stage?B??patients showed that the PS(P=0.001)and whether received TKI therapy(P<0.001)were the independent factors.ConclusionYoung patients with lung adenocarcinoma incidence has an increasing trend.They had high proportion of women and poor cell differentiation.Also they can get benefits from the EGFR-TKI treatment..Cox regression analysis of 260 patients showed that the age?PS?TNM stage were the independent factors.Cox regression analysis of the stage IIIB?IVpatients showed that the PS and whether received TKI therapy were the independent factors.