Abstract
To explore the epidemiological characteristics and prognosis of lung cancer in patients aged under 45 years old in northern China. The population-based database about lung cancer cases aged under 45y selected form the Hebei Provincial Cancer Registry Center from 2010–2015. Mortality data of young death from 1973 to 1975, 1990 to 1992, and 2004 to 2005 were extracted from the national retrospective survey of death. Mortality rates were calculated by the mortality database above in this analysis. Consecutive, 954 non-selected younger patients (< 45 years) and 2261 selected older patients (≥ 45 years) with pathologically diagnosed lung cancer treated at the Fourth Hospital of Hebei Medical University were included as the hospital-based database. Epidemiological, treatment outcomes and prognosis status from 2010 to 2017 were documented. A comparison with younger and older patients was also made. Multivariate analysis with young lung cancer patients was calculated by Cox regression model. The younger lung cancer mortality rate tended to slightly increase in Hebei Province, from 1.04 per100 000 in 1973 to 2.01 per 100 000 in 2015, but the PDR tended to decrease over the last 40 years. There were 954 younger and 2261 older lung cancer patients included in the hospital-based database. The proportions of patients who were female (50.84% vs 34.85%), family history of cancer (12.37% vs 6.32%), advanced stage at diagnosis (65.46% vs 60.77%) and adenocarcinoma (65.27% vs 61.11%) were relatively higher in the younger group than in the older group. The median OS were 23.0 months and 27.0 months between younger and older, the OS difference existed between the two groups (P = 0.001). In the younger patients, Cox regression showed that a family history of cancer, symptoms at diagnosis, pathology, stage at diagnosis and surgery were confirmed as independent factors affecting the prognosis. Mortality rates among younger lung cancer patients showed an increasing trend in northern China. The younger account for small but have unique characteristics, with higher proportions of female, family history of cancer, adenocarcinoma and advanced stages than the older group and had a trend of worse OS.
Highlights
Lung cancer, which has a variety of histological subtypes, is a multi-step and multi-factorial disease
The results consistently suggested that lung cancer cases in young patients may constitute a clinical entity with distinct clinical and pathological characteristics, with fewer patients who were smokers, more female patients, a predominance of adenocarcinoma and a more advanced stage at initial diagnosis[13,14,15]
The results showed that the mortality rate has increased in younger lung cancer patients over the last 40 years, and a family history of cancer, symptoms at diagnosis, advanced stage at diagnosis, adenocarcinoma and no surgical treatment were independent negative prognostic factors in younger lung cancer patients in Hebei Province
Summary
Lung cancer, which has a variety of histological subtypes, is a multi-step and multi-factorial disease. Few large-scale population- or hospital-based studies involving younger Chinese lung cancer patients and assessing detailed data on epidemiological, clinical and prognostic factors have been conducted. We analysed data on younger lung cancer patients from the national retrospective survey of mortality, a population-based cancer registry and a hospital-based database of lung cancer cases in young patients in Hebei Province. Because of the distinct biological behaviour of lung cancer in the younger population, limited number of previous studies and conflicting results, there was a pressing need to conduct this study to confirm the epidemiological and clinical characteristics by analysing the previously controversial factors and assessing the factors not yet investigated in this population
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