Bryant Ayesha S, Cerfolio Robert J
Section of Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ann Thorac Surg. 2008 May;85(5):1735-9; discussion 1739. doi: 10.1016/j.athoracsur.2008.01.031.
The purpose of this study was to investigate differences in epidemiology, types of presentation, time between diagnosis and treatment, tumor characteristics, and survival in patients 45 years or younger with non-small cell lung cancer.
A nested case-control study was conducted during 7 years using a prospective database of patients with non-small cell lung cancer. Younger patients (<45 years of age) were matched 1:2 with older patients for stage, sex, performance status, and type of resection.
There were 762 patients (254 were <45 years old, 508 controls were older). The median time from initial symptom to thoracic surgical consultation was significantly longer for those younger than 45 years (6.5 versus 2.8 weeks; p < 0.001). Younger patients were more likely to be symptomatic at the time of diagnosis (89% versus 68%; p < 0.001) and less likely to be smokers (45% versus 78%; p < 0.001). Kaplan-Meier analysis showed the time between diagnosis and treatment, symptoms, maximum standardized uptake value on positron emission tomography, and smoking status impacted survival. Only symptoms and smoking status impacted survival on Cox proportional hazards survival analysis among completely resected patients; 5-year survival was lower in the younger group compared with the older group (51% versus 62%; p = 0.037).
Despite similar stages and tumor characteristics patients younger than 45 years of age with non-small cell lung cancer have a significantly worse prognosis than older patients. Although they are more likely to be symptomatic, younger patients have a greater delay in seeking thoracic surgical care. These data should be considered in the treatment strategy offered to younger patients with non-small cell lung cancer.
本研究旨在调查45岁及以下非小细胞肺癌患者在流行病学、临床表现类型、诊断与治疗间隔时间、肿瘤特征及生存率方面的差异。
利用非小细胞肺癌患者前瞻性数据库进行了一项为期7年的巢式病例对照研究。年龄较小的患者（<45岁）与年龄较大的患者按1:2的比例进行分期、性别、体能状态及切除类型的匹配。
共有762例患者（254例年龄<45岁，508例为对照，年龄较大）。45岁以下患者从初始症状到胸外科会诊的中位时间显著更长（6.5周对2.8周；p<0.001）。年龄较小的患者在诊断时更易出现症状（89%对68%；p<0.001），且吸烟的可能性较小（45%对78%；p<0.001）。Kaplan-Meier分析显示，诊断与治疗间隔时间、症状、正电子发射断层扫描最大标准摄取值及吸烟状态会影响生存率。在完全切除的患者中，Cox比例风险生存分析显示只有症状和吸烟状态会影响生存率；较年轻组的5年生存率低于较年长组（51%对62%；p=0.037）。
尽管分期和肿瘤特征相似，但45岁以下非小细胞肺癌患者的预后明显比年长患者差。虽然年龄较小的患者更易出现症状，但他们寻求胸外科治疗的延迟时间更长。在为45岁以下非小细胞肺癌患者提供治疗策略时应考虑这些数据。
