Advanced non-small cell lung cancer in patients aged 45 years or younger: outcomes and prognostic factors

Abstract

BackgroundLung cancer in young patients (less or equal to 45 years) is uncommon and has clinical characteristics different from that in older patients. We investigated the outcomes and prognostic factors of young patients with advanced non-small cell lung cancer (NSCLC).MethodsFrom January 2000 to December 2009, we enrolled patients aged ≤45 years and diagnosed with stage IIIB or IV NSCLC. Their clinical data, including age, gender, performance status, histologic types, disease stages, laboratory data at diagnosis, treatment modalities, and survival were reviewed and analyzed. A Cox proportional hazard model was used to calculate the hazard ratio (HR) and its 95% confidence interval (CI).ResultsA total of 144 patients with advanced NSCLC were included. Female patients were more prevalent (n = 74, 51.4%). Adenocarcinoma was the most common histologic type (n = 119, 82.6%) in both genders (male, n = 54, 77.1%; female, n = 65, 87.8%). Epidermal growth factor receptor (EGFR) sequences were determined using tumor specimens from 58 patients, and 29 showed an EGFR mutation. No significant difference in median survival was found between patient groups with and without the EGFR mutation (798 vs. 708 days, p = 0.65). In multivariate analysis, male gender (HR, 1.70; 95% CI: 1.08-2.68), body mass index (BMI) less than 25 kg/m2 (HR, 2.72; 95% CI: 1.39-5.30), stage IV disease (HR, 2.62; 95% CI: 1.50-4.57), and anemia (HR, 2.08; 95% CI: 1.15-3.77) were associated with a short survival time.ConclusionsLow BMI, stage IV disease, anemia at diagnosis, and male gender were the negative prognostic factors for young patients with advanced NSCLC.

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

“…When compared to other studies, our results show that certain clinical variables were consistently associated with survival, including age < 50 as well as gender and stage [3,6,11]. In a SEER analysis, five-year overall survival was significantly better in a group younger than 50 years of age (16.1% vs. 13.4%; P < .001), principally as a result of better survival in patients with presumably curable (localized or early stage) disease (48.7% vs. 35.4%; P < .001) [7].…”

“…There have been numerous papers focused on young NSCLC patients, each with varying definitions of "young" [5][6][7][8]. Some of these studies attempted to compare outcomes between younger and older NSCLC patients.…”

“…Many of these prior studies attempted to define clinical characteristics predictive of outcome for young NSCLC patients. However, most of these papers had very limited sample sizes and/or were derived from single institution databases, hence limiting their generalizability [6,9,11].…”

Clinical Outcomes and Prognostic Factors Associated with the Response to Erlotinib in Non-Small-Cell Lung Cancer Patients with Unknown EGFR Mutational Status

“…Of these prognostic factors, PS, weight loss, and the number of prior regimens played a significant prognostic role for OS in our study. In two recent retrospective studies, an ECOG PS of 2 or more, elevated serum LDH, and the absence of skin rash (Kim et al, 2010), as well as low BMI, stage IV disease, anaemia at diagnosis, and male gender (Hsu et al, 2012), were shown to be adverse prognostic factors for OS. Unlike these previous studies, the presence of an intra-abdominal metastasis was a negative prognostic factor for survival in patients with metastatic NSCLC treated with erlotinib in our study.…”

“…However, in general, these analyses included only patients receiving first-line chemotherapy and cytotoxic therapy (Massarelli et al, 2003). Few reports have studied the prognostic factors for patients with NSCLC receiving second-or even third-line targeted therapies (Massarelli et al, 2003;Hsu et al, 2012). Our scoring system includes clinical factors instead of molecular markers.…”