Young lung cancer patients undergoing surgery: Comparison of clinicopathological characteristics and outcomes in patients aged ≤50 years versus >50 years

Objective

We investigated clinicopathologic characteristics, overall survival (OS), and locoregional recurrence-free survival of young surgical patients with non–small cell lung cancer.

Methods

Retrospective review of an institutional database of patients aged 50 years or younger undergoing resection for non–small cell lung cancer between January 1995 and March 2022. A control group of patients older than age 50 years was selected by stratified random sampling. Relevant characteristics were compared with Wilcoxon rank sum,χ,² and Fisher exact tests. Propensity-score weighting was used to control for confounders. OS and locoregional recurrence-free survival were analyzed with Kaplan-Meier and Cox proportional hazards regression.

Results

We identified 196 patients aged 50 years or younger and 232 patients older than age 50 years. Median age was 46 years (interquartile range, 43-49 years) in the younger group and 69 years (interquartile range, 63-74 years) in the older group. Younger patients were more often women, non-White, and with fewer comorbidities. They more often presented with symptoms, stage III or IV disease, and more often received neoadjuvant therapy. In unweighted analysis, younger patients showed superior OS (log-rank P < .0001). After propensity score weighting for procedure type, histologic type, Charlson Comorbidity Index, and smoking status, there was no significant difference in OS at 5 years between younger and older groups (70.62% vs 72.99%; weighted log-rank P = .084). Younger patients showed superior OS (weighted log-rank P = .0006) and locoregional recurrence-free survival (weighted log-rank P = .017) for clinical stage I, but not any other stage. lymphovascular invasion was an independent risk factor for worsened OS and locoregional recurrence-free survival across ages.

Conclusions

Recognizing lung cancer as a differential diagnosis for patients aged 50 years or younger is crucial because this group shows superior outcomes for stage I disease. Lymphovascular invasion is an independent prognostic risk factor across age groups.