University of Southern Denmark Lung cancer in younger patients Abbasowa,

INTRODUCTION: Lung cancer remains a leading cause of cancer-related death. The incidence increases with age and the occurrence in young patients is relatively low. The clinicopathological features of lung cancer in younger patients have not been fully explored previously. METHODS: To assess the age differences in the clinical characteristics of lung cancer, we conducted a retrospective analysis comparing young patients ≤ 65 years of age with an elderly group > 65 years of age. Among 1,232 patients evalu ated due to suspicion of lung cancer in our fast-track setting from January-December 2013, 312 newly diagnosed lung cancer patients were included. RESULTS: Patients ≤ 65 years had a significantly higher representation of females (p = 0.0021), more frequent familial cancer aggregation (p = 0.028) and a lower incidence of squamous cell carcinoma (p = 0.0133). When excluding pure carcinoid tumours, a significantly higher proportion of the younger patients presented with advanced stage disease (p = 0.0392). Combined modality therapy was more common in younger patients (p = 0.0009), while chemotherapy appeared less prevalent among the elderly (p = 0.0015). CONCLUSIONS: Lung cancer in younger patients comprises a distinct clinicopathological entity with more frequent advanced stage disease and a significantly greater proportion with a family history of cancer. Implementing genetic background assessments and considering lung cancer as a possible diagnosis in younger, symptomatic patients, is of paramount importance. FUNDING: none. TRIAL REGISTRATION: The study was approved by the Danish Data Protection Agency. Lung cancer is among the most common malignancies worldwide. In 2012, the death rate from lung cancer almost reached the combined mortality from breast, prostate and colon cancer [1]. Lung cancer has an overall five-year survival of 17%; however, when diagnosed in early stages, it is possible to offer treatment with a curative intent which raises the five-year survival to > 50% [2]. Lung cancer typically affects elderly individuals. Approximately two out of three patients diagnosed with lung cancer are 65 years or older; fewer than 2% of all cases are found in patients younger than 45 years of age [1]. The average age at diagnosis is about 70 years [1]. As our clinical impression is that younger patients present in more advanced stages, we conducted a retrospective analysis to examine the clinical characteristics and management of a cohort of newly diagnosed lung cancer patients. mEThOds The medical records of patients referred for evaluation of suspected lung cancer at Vejle Hospital in 2013 were reviewed for epidemiologic data and clinical history. During this period, 1,232 patients were evaluated in our fast-track setting, and in 332 patients the diagnosis was confirmed. The following parameters were extracted and analysed: age, gender, smoking habits, occupational/environmental exposure to asbestos, previous cancer, selfreported familial history of cancer, symptoms, performance status (PS) as defined by the Eastern Cooperative Oncology Group [3], clinical stage, cytological/histological subtype, diagnostic procedures and treatment. Cyto-histopathology was categorised according to the World Health Organization classification of lung tumours, whereas clinical staging was based upon the international tumour-node-metastasis system as defined in the seventh edition by the The International Union Against Cancer in 2010 [4]. Patients with intrathoracic metastases from extrapulmonary cancer (n = 1) without unambiguous clinical staging or sufficient biopsy verification (n = 19) were excluded from the analysis. Eligible patients were categorised into four groups according to age: ≤ 55 years, 56-65 years, 66-75 years and finally > 75 years (Table 1, Table 2 and Table 3). Statistical analyses were performed on combined age groups, comparing the clinicopathological features of patients ≤ 65 years (defined in the following as younger patients) with patients > 65 years (defined in the following as elderly patients). We conducted all statistical analyses using 2 × 2 contingency tables in GraphPad software. p-values were calculated by Fisher’s two-tailed exact test due to low numbers in some calculations when absolute numbers were compared. Welch’s t-test was utilised for mean value comparisons. Trial registration: The study was approved by the Danish Data Protection Agency. lung cancer in younger patients Leda Abbasowa1 & Poul Henning Madsen2