Clinical and Imaging Features of Non–Small-Cell Lung Cancer in Young Patients

Abstract

Nonesmall-cell lung cancer (NSCLC) in young patients is rare. We retrospectively analyzed the presenting symptoms, clinicopathologic characteristics, and imaging features of 166 young patients with NSCLC. We found that young patients with NSCLC often present with nonspecific symptoms and have advanced disease at diagnosis, which can mimic other pathologies. Targetable genomic alterations are common and may drive imaging features. Background: Nonesmall-cell lung cancer (NSCLC) in young adult patients is rare, with scarce data available in patients aged < 40 years and even less in those aged < 35 years. Our goal was to determine the presenting symptoms, clinicopathologic characteristics, and imaging features of young patients with NSCLC at time of diagnosis and compare them to those of older adults. Patients and Methods: We retrospectively analyzed the medical records and imaging of young patients ( 40 years old) with NSCLC treated at our institution between 1998 and 2018. Patients < 35 years old were compared to those between 35 and 40 years old. Characteristics of patients 40 years old were compared to older patients (> 40 years) from publicly available data sets. Results: We identified 166 young patients with NSCLC (median age, 36.6 years; range, 18-40 years). Most presented with nonspecific respiratory symptoms and were diagnosed with pneumonia (84/136, 62%). Compared to patients < 35 years old, patients 35-40 years old were more likely to have malignancy detected incidentally (15% vs. 5%, P ¼ .04). Patients < 35 years old were more likely to have central tumors (55% vs. 33%, P ¼ .02) and to have bone (38% vs. 19%, P ¼ .007) and lung (39% vs. 24%, P ¼ .03) metastases. Compared to older patients (> 40 years), young patients were more likely to be never smokers (65.0% vs. 14.7%, P < .001) and to have advanced disease (88% vs. 66%, P < .001). Conclusion: Young patients with NSCLC often present with nonspecific symptoms and have advanced disease at diagnosis, often mimicking other pathologies. Awareness of the clinical presentation and imaging features of NSCLC in young patients may help minimize delays in diagnoses.

Small cell lung cancer in young patients: trends in sociodemographic factors, diagnosis, treatment, and survival

“…Lung cancer is primarily a disease of the older population, with about 10% of patients <55 years at diagnosis (10). Several studies have revealed that younger patients with non-small cell lung cancer (NSCLC) represent a distinct clinico-biologic entity (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Compared to older adults, young NSCLC patients are more likely to be women, Asians, or Pacific Islanders, have adenocarcinoma histology, and present with metastases (11)(12)(13)(16)(17)(18)(19).…”

The role of psychiatry in quality of life in young patients with non-small cell lung cancer

“…About 65% of patients who are diagnosed with AC are non-smokers. NSCLC remains the leading cause of cancer-related mortality in the United States and around the world ( Garrana et al, 2021 ). This cancer type is usually diagnosed in patients in the 6th and 7th decades of life, with less than 5% seen in patients below age 50 and even fewer below age 40 ( Sacher et al, 2016 ; Piccirillo et al, 2004 ; Jorgensen et al, 2012 ).…”

“…NSCLC is extremely rare in young adults, who we defined developmentally between 18 and 35 years of age. Other cancers such as lymphoma, melanoma, sarcoma, breast and testicular cancers occur more frequently in this age group and are the leading cause of mortality in the young adult age group ( Garrana et al, 2021 ).…”

“…Studies have shown that young patients with NSCLC have different clinical and pathological features leading to different outcomes when compared to older patients. Young adults often present with adenocarcinoma ( Chen et al, 2019 ) and have molecular alteration, with the most common being anaplastic lymphoma kinase (ALK) rearrangements and epidermal growth factor receptor (EGFR) mutations ( Garrana et al, 2021 ). Distinct lung cancer with separated genetic pathways that are caused by discrete mutations in tumor-promoting genes called driver mutations are also seen in people who never smoked.…”

“…Since patients are at the peak of reproductive years, infertility resulting from chemotherapy is an important consideration ( Benedict et al, 2016 ). Financial difficulties due to unemployment and being uninsured are of significant concern compared to other age groups ( Garrana et al, 2021 ). Young adults with lung NSCLC may be faced with psychological and emotional issues, as the diagnosis rises at a time where rapid changes in cognitive and emotional development transpire ( Zebrack, 2011 ).…”