| Objective:Lung cancer in young patients is a distinct disease with particular society implications.However,the current research data are limited,and difficult to reflect the whole picture.The aim of this study was to elucidate the clinical and pathological features of this distinctive entity,and guide clinical practice in finding the best interventions to achieve optimal therapeutic outcomes.Methods:A retrospective review of patients with lung cancer was performed in First Hospital,Jilin University from January 2010 to June 2017.Young patients were defined as between 18 and 35 years old.The following data were retrieved: age,sex,family history,personal history(including smoking and alcohol consumption),pathological tumor type,tumor location,tumor stage,gene mutation assessment and interventions,including surgery,chemotherapy,radiotherapy and targeted management;and overall survival(OS).OS was defined as the interval from diagnosis to death or latest follow-up,and calculated in months.The end date for last follow-up was April 30,2018.Demographic,clinicopathological,therapeutic and prognostic data were systematically analyzed.Cumulative survival curves were generated by the Kaplan-Meier method and differences in survival rates compared using the log-rank(Mantel-Cox)and/or Gehan-Breslow-Wilcoxon tests.P < 0.05 was considered to have statistically significant.Results:From a total of 8,734 patients,120 cases(1.37%)were young patients,of which 82 cases with complete hospital records were included in this study.The mean age of them at diagnosis was 31.39 years old and the proportion was similar in both sexes(M : F ratio,1.16 : 1).The proportion of lung adenocarcinoma(45%)was the highest,second place was in small cell lung cancer(26%),following was squamous cell carcinoma(11%),and other types were less.Regarding primary site in the diseases,there was no predilection for either the left or right lung(L : R ratio,0.82 : 1).At the time of initial diagnosis,the proportion of advanced diseases was higher(49.21% stage IV).Pleura(38.71%)was the most common metastatic site,and followed by bone(35.48%)and lung(25.81%).The majority(68%)in the patients had single organ metastasis.There was an increased frequency of gene mutations in the young patients.There was clear genetic status record in 53 patients,while genetic testing was not performed for 35 patients during hospitalization.Among 18 patients examined for epidermal growth factor receptor(EGFR)and anaplastic lymphoma kinase(ALK)mutations,there were 15 positive mutations of these driver genes,10 sensitive EGFR mutations,5 clear ALK rearrangements,and only 3 negative mutations of driver genes.The 1-year overall survival(OS)rate in the patients was 62.31% and the 3-and 5-year survival rates of them were both 53.31%;median OS was not achieved(range,3–86 months).Male,negative or unknown gene mutation status,stage IV,and squamous or small cell lung cancer were associated with poor prognosis(OS)in early-onset lung cancer.Conclusions:1.Lung cancer in young patients shows distinctive clinical features with adenocarcinoma and stage ?.2.Lung cancer in young adults is higher frequency in genetic changes.Evaluation of genetic mutations in this subgroup should be highly recommended as individualized targeted therapies may achieve superior therapeutic outcomes.3.Male,negative or unknown gene mutation status,stage IV,and squamous or small cell lung cancer were associated with poor prognosis(OS)in early-onset lung cancer. |
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