Frequent genomic alterations and better prognosis among young patients with non-small-cell lung cancer aged 40years or younger.

Abstract

The subgroup of young patients with non-small-cell lung cancer (NSCLC) is poorly understood. We retrospectively studied the clinical characteristics, gene mutations, and outcomes of patients with NSCLC (aged≤40years). Of the 7494 patients with lung cancer diagnosed from February 2001 to October 2016, 252 aged≤40years showed NSCLC. We divided their cases into non-squamous cell carcinoma and squamous cell carcinoma groups according to their histology results. Of the 252 young NSCLC patients, 173 (69%) patients had stage IIIB or IV, and 196 (78%) had never smoked. The four most common metastases were intrapulmonary lesions, pleura, bone, and brain. Among patients with adenocarcinoma, 29 (40%, n=73) harbored epidermal growth factor receptor (EGFR) mutations, 25 (34%, n=74) harbored anaplastic lymphoma kinase (ALK) translations, and 1 (14%, n=7) harbored ROS proto-oncogene 1 receptor tyrosine kinase (ROS1) translations. The median progression-free survival (PFS) and overall survival (OS) were 3.3 and 27.6months for patients receiving chemotherapy (n=65), and 12.1 and 33.6months for patients receiving EGFR tyrosine kinase inhibitors (TKIs) (n=13), respectively. Patients receiving crizotinib had a median PFS time of 21.9months (n=8). Young patients are associated with an increased likelihood of gene mutations and can receive a better prognosis when patients harboring gene mutations are treated with EGFR-TKIs or ALK inhibitors.