Abstract

Lung cancer is relatively rare in young patients as the median age at diagnosis is 65–70 years. The main objective of this nationwide study was to investigate the characteristics of young lung cancer in Taiwan, especially the relationships among smoking behavior, epidermal growth factor receptor (EGFR) mutation, and age. The National Taiwan Lung Cancer Registry, a database contain detailed cancer statistics, was analyzed in this study for the period 2011–2012. Young lung cancer was defined as age ≦ 45 years. There were 21,536 lung cancer patients (13,187 men and 8349 women). Among these patients, 1074 (5.0%) were in the younger group, and 20,462 patients (95.0%) were in the older group. Female gender (48.8% versus 38.2%, P < 0.001), never-smokers (47.3% versus 43.8%, P = 0.015), and adenocarcinoma (70.4% versus 58.1%, P < 0.001) were more frequent in the younger group. While the EGFR mutation rate was lower in the younger group (52.5% versus 60.6%, P = 0.001), the primary site of lung cancer and stage distribution were not significantly different. If only adenocarcinoma patients were included in the analysis, female gender, older age, and never-smokers were more likely to have EGFR mutation. In conclusion, lung cancer in young patients (≦ 45 year-old) was associated with unique characteristics, with greater percentages of female patients, adenocarcinoma, and never-smokers and a lower EGFR mutation rate compared with older patients.

Highlights

  • Lung cancer is the leading cause of malignancyrelated mortality worldwide [1]

  • Among patients with known smoking status and adenocarcinoma, the epidermal growth factor receptor (EGFR) mutation test was performed in 59.9% of the younger patients and in 56.1% of the older patients

  • The EGFR mutation rate was significantly lower in the younger patients compared with the older patients (52.5% versus 60.6%, P = 0.001)

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Summary

INTRODUCTION

Lung cancer is the leading cause of malignancyrelated mortality worldwide [1]. There are fewer studies on young lung cancer patients, i.e., those less than 40 years of age, owing to the fact that the median age of lung cancer at diagnosis is 65–70 years [2]. Smoking status and EGFR mutation were important factors in the current lung cancer study. In the treatment of advanced NSCLC, the first-line use of gefitinib or erlotinib, an orally administered tyrosine kinase inhibitors (TKIs) of EGFR, was recommended for patients harboring EGFR mutation with improvement of the progression-free survival and acceptable toxicity [7, 8]. The epidemiological study of EGFR mutations demonstrated higher frequency among adenocarcinoma histology, never-smoking status, and Asian ethnicity [9,10,11]. No large-scale survey of Asian young lung cancer with detailed data on smoking and EGFR status has been conducted. The main objective of this nationwide study was to investigate the characteristics of young adult lung cancer in Taiwan, especially the relationships among smoking behavior, EGFR mutation, and age. Detailed smoking status and EGFR results have been routinely surveyed and documented in the database since 2011

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