Clinical Characteristics And Gene Mutation Of Young Patients With Lung Adenocarcinoma

Objective: The lung cancer incidence trends to rise year by year in the world,and the percentage of adenocarcinomas is increasing day by day.According to statistics,the average age of initial diagnosis of lung cancer in the world is about 70 years old.Although the majority of lung cancer patients are still elderly,the onset age of the younger trend is more and more obvious.Occurrence at a younger age has been demonstrated to be associated with a distinct biology in non-small cell lung cancer.However,genomics and clinical characteristics among younger patients wit h lung adenocarcinoma remain to be determined.Here we studied the potential ly targetable genetic alterations by next-generation sequencing(NGS)assay in young Chinese patients with lung adenocarcinoma.The aim of this study was to elucidate the clinical and genetic features of this distinctive entity,and guide clinical practice in finding the best interventions to achieve optimal therapeutic outcomes.Methods: Collected the clinical date of patients who diagnosed with primary lung adenocarcinoma from the Affiliated Hospital of Qingdao University between 2013.01.and 2019.06.One hundred eighty-four patients of adenocarcinoma were selected for NGS detection to obtain gene characteristics for research and analysis.Among them,eighty-nine patients were less than or equal to 45 years old,and ninety-five patients were older than 45 years old.The information of 184 patients were collected as follows: age,sex,smoking history,tumor stage,tissue source,gene mutation frequency.To study the relationship between age,general clinical characteristics and gene mutation in patients with lung adenocarcinoma.Pearson's chi-squared test,Fisher exact test and Student t test were used to analyze gene mutation and patient characteristics between the two groups.P<0.05 was considered to have statistically significant.Results: A total of 184 cases were divided into the young group and the old group by taking the 45-year-old as the dividing line.There were significant differences in age,smoking history and age distribution between the young group and the old group.The young group had less smokers and more patients with early adenocarcinoma.There was no significant difference in the source of tumor samples between the two groups.The frequencies of targetable genetic alterations in 184 patients with lung adenocarcinoma were analyzed by defined age categories,which unveiled a distinctive molecular profile in the younger group,aged less than 45 years.Notably,higher frequency of ALK and HER2 genetic alterations were associated with young age.However,a reverse trend was observed for KRAS,STK11 and EGFR exon 20 mutations,which were more frequently identified in the older group,aged more than 45 years.Furthermore,concurrent EGFR/TP53 mutations were much more prevalen t in the younger patients(81.6% vs.44.9%),which might have a poor response to treatment with epidermal growth factor receptor tyrosine kinase inhibitor.Conclusion: In this study,NGS assay revealed a distinctive genetic profile in younger patients with adenocarcinoma and may have different mechanisms of tumorigenesis.Patients with lung cancer who are younger than 45 years old might have a significantly poorer prognosis than that of older patients.High frequency of concurrent EGFR/TP53 mutations was found in the younger patients,which especially warranted personalized treatment in this population.Young patients with lung adenocarcinoma are a group of people who are less studied,and a special group with abundant targeted gene mutations.High-throughput sequencing should be highly recommended for these patients to guide personalized management and achieve precision treatment.The survival benefit of this group of patients will be greatly extended with the rapid development of gene mutation site detection methods and the development of targeted drugs.