Retrospective Study On The Clinical Features And Prognostic Factors Of Young Lung Cancer Patients

Objective:Lung cancer is the malignant tumor with the highest morbidity and mortality in the world today.It often occurs in the elderly over 50 years old.At present,a large number of clinical studies have been conducted worldwide to analyze the clinical characteristics and prognostic factors of the elderly patients with lung cancer.Recently,the investigation found that the age of lung cancer tends to be younger.For this special group,there are few clinical reports.In this regard,we observed the clinical characteristics of young lung cancer patients admitted to The First Affiliated Hospital of Anhui Medical University who were diagnosed with age less than or equal to 40 years old,and analyzed the factors affecting their survival and prognosis,as to provide references for the formulation of diagnosis and treatment strategies for this young population.Methods:This study collected clinical data of 251 young lung cancer patients admitted to our hospital between January 1,2000 and July 1,2019.All the included patients were aged less than or equal to 40 years at the time of diagnosis,the time of death was clearly known through follow-up,and they were confirmed as primary lung cancer by histopathology or cytology.The basic information of all patients,the characteristics of the disease,the diagnosis and treatment process,the driving gene mutation were observed.The time of death was learned through case tracking and calling,and the over survival was calculated.The data were collated and analyzed to calculate the 1-year,3-year and 5-year survival rates,respectively.251 young lung cancer patients were divided into groups according to gender,age,diagnosis time,smoking status,pathological histological type,diagnosis stage and whether they received targeted therapy.Univariate prognostic analysis was performed,and Kaplan-Meier survival curve was plotted for log-rank test.Subsequently,the statistically significant factors in univariate prognostic analysis were introduced into Cox regression equation model for multivariate prognostic analysis.Since SCLC and NSCLC staging standards were different,only 168 NSCLC cases were included in the multivariate analysis.By calculating the regression equation,the independent factors affecting the survival and prognosis of young NSCLC patients were obtained.P<0.05 was considered statistically significant.Results:The onset age of young lung cancer patients was 18-40 years old,with an average age of 34.5 years old.The most common histopathological type was adenocarcinoma(56.8%),and the vast majority of patients(92.3%)were diagnosed with advanced stage.Cough(55.8%)was the most common cause of first visit.Biopsy by fiberoptic bronchoscopy(37.1%)is the most widely used diagnostic method.Bone(51.8%)was the most common site of distant metastases.All the patients with early-stage young lung cancer(13.1%)had received surgical treatment,and more than half of the patients(63.7%)had received chemotherapy in our hospital,among which48 were treated with radiotherapy.Among the 37 young lung cancer patients who were sent for the driver gene test and received the exact results,a total of 27(73.0%)of them were positive for the driver gene test and received targeted drug therapy to varying degrees.By calculating the survival rate,the 1-year survival rate was 65.3%,the 3-year survival rate was 23.9%,and the 5-year survival rate was 15.1%.Univariate prognostic analysis suggested that the survival time of young lung cancer patients was correlated with smoking status(P=0.031),histopathological type(P=0.039),TNM stage at diagnosis(P<0.001),and whether they received targeted therapy(P=0.004).Multivariate prognostic analysis suggested that TNM stage(P<0.001)and histopathological type(P=0.004)at the time of diagnosis were independent prognostic factors affecting young NSCLC patients.Conclusion:1.High incidence of adenocarcinoma and advanced stage at first diagnosis are the most significant clinical characteristics of young lung cancer patients.2.The mutation rate of driver gene was higher in young NSCLC patients,with EML4-ALK as the main index.3.Early diagnosis and treatment make young lung cancer patients more benefit in terms of survival.