Predictors of survival for younger patients less than 50 years of age with non-small cell lung cancer (NSCLC): A California Cancer Registry analysis

doi:10.1016/j.lungcan.2014.04.007

Lung Cancer

Volume 85, Issue 2, August 2014, Pages 264-269

https://doi.org/10.1016/j.lungcan.2014.04.007 Get rights and content

Abstract

Background

Non-small cell lung cancer (NSCLC) is uncommonly diagnosed in patients younger than 50 years of age. We analyzed the California Cancer Registry (CCR) to describe epidemiologic characteristics and outcomes in this patient subset and to identify factors prognostic for cause-specific survival (CSS).

Methods

Patients diagnosed with NSCLC between 1/1/98 through 12/31/09 and reported to the (CCR) as of October 2011 were included. The primary outcome measure was CSS. Cox regression models were used to evaluate predictors of CSS in young patients with NSCLC, adjusted for potential confounders. Interaction analysis was performed between age groups (<50 vs. ≥50) and specific demographic and tumor covariates.

Results

We identified 132,671 lung cancer cases, of which 114,451 (86.3%) had NSCLC. Of these, 6389 (5.6%) were < 50 years of age (median, 46 years). The most common histology was adenocarcinoma (3697, 57.9%). Most patients had stage III (1522, 23.8%) or IV (3655, 57.2%) disease. Fewer young patients were diagnosed in recent years (n, % of total NSCLC population of that era): 1998–2001 (2355, 6.0), 2002–2005 (2182, 5.7), and 2006–2009 (1852, 5.0), P < 0.001. Multivariate analysis showed that age <50 years was an independent predictor of improved CSS (HR 0.827, P < 0.001). Significant predictors of better CSS in patients <50 years included female sex, Asian or Hispanic ethnicity, lower stage, later year of diagnosis, and higher socioeconomic status, among others. Adenocarcinoma histology was not associated with improved CSS in this patient subset (HR 0.987, P = 0.78). Interaction analysis revealed that Hispanic race and bronchioloalveolar histology had differential CSS outcomes dependent on age group.

Conclusions

This large registry study found that age <50 years is an independent predictor of improved CSS. Variables prognostic for CSS differed somewhat from those in older patients.

Section snippets

Background

Lung cancer will be diagnosed in approximately 200,000 Americans in 2013 and unfortunately remains the leading cause of cancer-related death in both men and women in the United States [1]. Among the subtypes of lung cancer, non-small cell lung cancer (NSCLC) is the most prevalent, accounting for 85% of all new cases. Lung cancer is more common in older individuals, with an average age at diagnosis of 68 years and about a third of patients over 70 years of age [2]. Recent reports have suggested

Methods

The objectives of the present study are (1) to describe the demographic characteristics and epidemiologic trends in the NSCLC population in the CCR from 1998 to 2008 with a focus on younger patients (<50 years of age); (2) to assess cause-specific survival (CSS, the primary outcome measure) in this younger cohort, and (3) to develop multivariate logistic regression survival models (adjusted for relevant variables) in order to identify baseline features prognostic CSS in younger patients with

Patient characteristics

A total of 132,671 lung cancer patients were identified for this study, 114,451 with NSCLC (Table 1). Of these, 6389 (5.5% of all NSCLC patients) were <50 years of age. Median age of this younger subset was 46 years (range: 6–49). Most younger patients were White (3557 patients, or 55.7% of the group), which was a lower percentage than the age-over-50 cohort. The most prevalent histology was adenocarcinoma, which accounted for 57.9% of all young patients and was of a higher proportion than in

Discussion

Lung cancer is generally a disease of older patients. Past studies either had conflicting results on the differential survival of young NSCLC patients relative to older patients, or were limited by very small sample sizes. We performed this study to evaluate factors that may influence survival in patients younger than 50 years using a large statewide tumor registry to overcome sample size limitations. We found that several baseline clinical features (including female sex, Asian or Hispanic

Conclusions

In conclusion, this large registry experience found that age < 50 years is an independent predictor of improved CSS (HR 0.827, P < 0.001) in the modern era. In addition, the proportion of young patients with NSCLC has decreased from 6.0% (1998–2001) to 5.0% (2006–2009). Importantly, in young patients BAC histology was not associated with improved survival as it is in the overall population with NSCLC. Finally, clinical variables independently prognostic for CSS were identified in the younger

Conflict of interest statement

None declared

Acknowledgements

This work was funded by the Division of Hematology and Oncology, Department of Internal Medicine, UC Davis School of Medicine and support (to MSL) was provided by the Davis Senior High School Blue and White Foundation. This work was presented in part at the 2013 American Society of Clinical Oncology Annual Meeting in Chicago, IL on June 1, 2013.

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Predictors of survival for younger patients less than 50 years of age with non-small cell lung cancer (NSCLC): A California Cancer Registry analysis

Abstract

Background

Methods

Results

Conclusions

Section snippets

Background

Methods

Patient characteristics

Discussion

Conclusions

Conflict of interest statement

Acknowledgements

J Thorac Oncol

J Thorac Oncol

Lung Cancer

Chest

J Thorac Oncol

Cancer statistics: 2013

CA Cancer J Clin

Lung cancer in young females

Eur Respir J

Trends in lung cancer mortality among young adults in Japan

Jpn J Clin Oncol

Multicenter analysis of lung cancer patients younger than 45 years in Shanghai

Cancer