Original article
General thoracic
Differences in Outcomes Between Younger and Older Patients With Non–Small Cell Lung Cancer

Presented at the Fifty-fourth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 7–10, 2007.
https://doi.org/10.1016/j.athoracsur.2008.01.031Get rights and content

Background

The purpose of this study was to investigate differences in epidemiology, types of presentation, time between diagnosis and treatment, tumor characteristics, and survival in patients 45 years or younger with non–small cell lung cancer.

Methods

A nested case-control study was conducted during 7 years using a prospective database of patients with non–small cell lung cancer. Younger patients (<45 years of age) were matched 1:2 with older patients for stage, sex, performance status, and type of resection.

Results

There were 762 patients (254 were <45 years old, 508 controls were older). The median time from initial symptom to thoracic surgical consultation was significantly longer for those younger than 45 years (6.5 versus 2.8 weeks; p < 0.001). Younger patients were more likely to be symptomatic at the time of diagnosis (89% versus 68%; p < 0.001) and less likely to be smokers (45% versus 78%; p < 0.001). Kaplan–Meier analysis showed the time between diagnosis and treatment, symptoms, maximum standardized uptake value on positron emission tomography, and smoking status impacted survival. Only symptoms and smoking status impacted survival on Cox proportional hazards survival analysis among completely resected patients; 5-year survival was lower in the younger group compared with the older group (51% versus 62%; p = 0.037).

Conclusions

Despite similar stages and tumor characteristics patients younger than 45 years of age with non–small cell lung cancer have a significantly worse prognosis than older patients. Although they are more likely to be symptomatic, younger patients have a greater delay in seeking thoracic surgical care. These data should be considered in the treatment strategy offered to younger patients with non–small cell lung cancer.

Section snippets

Patients

This is a nested case-control study from January 1999 to January 2006. Inclusion criteria mandated that all patients be older than 19 years old, have biopsy-proven NSCLC, and have been clinically staged using computed tomography (CT scan) and fluorodeoxyglucose positron emission tomography (PET) scan before surgical resection. Integrated PET/CT instead of dedicated PET was used after 2002. Patients who received neoadjuvant therapy of any kind were excluded from the study. A consecutive series

Results

There were 762 patients (254 patients were <45 years old and 508 patients were >45 years old). Table 1 shows a greater proportion of older patients had a history of smoking, and the median time until presentation for treatment was significantly longer for those younger than 45 years (6.5 versus 2.8 weeks; p < 0.001). It also shows that younger patients were more likely to be symptomatic at the time of diagnosis (89% versus 68%; p < 0.001). The most common presenting symptom in both groups was

Comment

Non–small cell lung cancer is mainly a cancer of the elderly. Despite this fact, there remain a significant number of young patients who present with NSCLC each year. On the basis of the findings of our study, this same disease exhibits separate clinicopathologic features in these two different age groups. In this study we showed that despite similar stage and tumor characteristics, younger patients with NSCLC have a significantly worse prognosis than older patients. These findings differ from

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