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Objective:
To determine differences in presentation, treatment and cancer-specific survival in patients ≤40 years with lung adenocarcinoma (LAC) when compared to their older counterpart
Design:Retrospective Cohort
Setting:
Surveillance, Epidemiology, and End-Results (SEER)database (2004-2007; 17 registries).
Patients:
Patients with primary lung adenocarcinoma on the SEER database
Main Outcome Measures:
Incidence; characteristics at presentation and treatment received; cancer-specific survival
Results:
The population-based incidence of primary LAC was 0.20/100,000 for patients ≤40 years (males: 0.18/100,000 vs. females: 0.24x100,000; p=0.015). There were 420 (0.9%) patients ≤40 years and 48,282 (99.1%) over 40 years. Younger patients were more likely to be female (p=0.036) and non-white (p<0.001). When compared to the older group, younger patients presented with greater T status (p<0.001), more nodal involvement (p<0.001) and metastatic disease (p<0.001). They presented more frequently with unresectable disease (76.1% vs. 59.9%, p<0.001) and underwent surgical resections less frequently (21.4% vs. 29.7%, p<0.001) compared to patients >40 years. Among those who underwent surgery, younger patients were less likely to receive sublobar resections (p<0.001) and lobectomy (p=0.007) and more likely to receive pneumonectomy (p=0.029). Rates of lymphadenectomy were similar. Younger patients were more likely to receive radiation therapy (p<0.001). Stage-for-stage, cancer-specific survival was similar for early stage lung cancer between younger and older groups (Stages I-II, p=0.0216) and better in the young for Stages III (p=0.0216) and IV (p<0.0001).
Conclusions:
Lung adenocarcinoma is uncommon in patients 40 years and younger and occurs more frequently in females. Younger patients have more advanced disease at diagnosis often precluding surgical options. Age at diagnosis appears to have no impact on survival for early-stage patients. However, cancer-specific survival for advanced disease is significantly better when compared to older patients