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Lung Cancer |

Clinicophatologic Behavior and Survival of Non-small Cell Lung Cancer in Young Patients. Analysis of a Single Institution's Experience Over 20 Years

Narjust Duma, MD; Dina Khateeb, DO; Richard May, MD; Maira DosSantos; Martin Gutierrez, MD
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Rutgers-New Jersey Medical School, Newark, NJ


Chest. 2015;148(4_MeetingAbstracts):553A. doi:10.1378/chest.2267961
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Abstract

SESSION TITLE: Lung Cancer Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Lung cancer is the most common cause of cancer death in the United States with a median age at diagnosis of 70 years. Early recognition of non-small cell lung cancer (NSCLC) in patients (pts) younger than 40 years is a challenge, as this population represents less than 5% of all cases. The aim of this study was to identify the unique clinical characteristics and survival in early onset lung cancer (<40 years).

METHODS: We reviewed the records all pts diagnosed with NSCLC at our institution from 1990 to 2012. Demographics, smoking history, tumor characteristics and survival were analyzed. Median survival was estimated using the Kaplan-Meier method and Cox regression was used for multivariate analysis.

RESULTS: Of 3875 pts, 316 (8.2%) were under the age of 40 years. Median age at diagnosis was 33 years (range, 17-39), there were more males than females 197 (62%) vs. 119 (38%).56% of the pts were current or former smokers and 7% had history of alcohol abuse. Regarding clinical characteristics: median ECOG was 0, hemoglobin 13, Creatinine 0.6 and BMI of 31m2/kg. At the time of diagnosis, 42% of the pts were stage IV with adrenal, liver and brain being the most common sites of distant metastases. Adenocarcinoma was the most common histologic subtype (61%) followed by squamous cell carcinoma. There was not a direct association regarding smoking history and histologic subtype. Median overall survival in the young pts (<40 years) was 18.3 months (95%CI: 11.2-22.7) and when compared with older pts (≥40 years) there was no significant difference in survival between both groups (P<0.83). African American descent (OR: 1.8, p<0.009), central tumor location (OR: 1.48, p<0.04) lymphovascular invasion (OR: 3.1, p<0.0001) and brain metastasis (OR: 4.5, p<0.0002) were independent and significant predictors of survival by multivariate analysis in the <40 years group of pts.

CONCLUSIONS: Histologically, adenocarcinoma was more common in pts <40 years. Almost half of the pts had advanced disease and good performance status at presentation. However, they did not have a survival benefit when compared with patients diagnosed at a later age.

CLINICAL IMPLICATIONS: Further research should aim to elucidate the specifics characteristics and signs of NSCLC in young pts, as this could potentially impact survival and screening modalities in this population.

DISCLOSURE: The following authors have nothing to disclose: Narjust Duma, Dina Khateeb, Richard May, Maira DosSantos, Martin Gutierrez

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