Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
School of Medicine, China Medical University, Taichung, Taiwan, ROC.
J Chin Med Assoc. 2020 May;83(5):461-465. doi: 10.1097/JCMA.0000000000000311.
This study aimed to analyze pathologic characteristics, treatment, prognosis, and tumor epidermal growth factor receptor/anaplastic large-cell lymphoma kinase (EGFR/ALK) mutation proportion of non-small cell lung cancer (NSCLC) patients aged <40 years at diagnosis.
We retrospectively reviewed data of NSCLC patients diagnosed at Taipei Veterans General Hospital between June 2007 and December 2014, aged <90 years at the time of the diagnosis.
We found 5051 cases of NSCLC, including 168 patients who were <40 years (younger group) and 4883 patients aged 40 to 89 years (older group). We found that the younger group had a significantly higher proportion of the EGFR mutation (22.6% vs 16.2%, p = 0.026) and the ALK mutation (4.2% vs 0.5%, p < 0.001) than the older group. Although the younger group included more stage IV patients (60.1% vs 49.6%, p = 0.002), it had a better overall survival (OS) rate (1 year: 73.7% vs 66.2%, p = 0.043; 5 years: 44.4% vs 33.7%, p = 0.004) (median survival time: 55 vs 26 months, p = 0.002). About the histologic subtype of NSCLC, the younger group presented less frequent cases of squamous cell carcinoma (4.2% vs 16.1%, p < 0.001), whereas the adenocarcinoma subtype was similarly frequent in the two groups (76.8% vs 76.5%, p = 0.924).
The OS rate in younger NSCLC patients was higher than that in the older NSCLC patients, despite the higher rate of stage IV NSCLC patients in the younger group. This survival benefit is most likely due to the higher proportion of the EGFR and ALK mutations and the corresponding tyrosine kinase inhibitor treatment.
本研究旨在分析诊断时年龄<40 岁的非小细胞肺癌（NSCLC）患者的病理特征、治疗、预后和肿瘤表皮生长因子受体/间变性淋巴瘤激酶（EGFR/ALK）突变比例。
我们回顾性分析了 2007 年 6 月至 2014 年 12 月期间在台北荣民总医院诊断的 NSCLC 患者的数据，这些患者在诊断时年龄<90 岁。
我们共发现 5051 例 NSCLC 患者，其中 168 例<40 岁（年轻组），4883 例年龄 40-89 岁（老年组）。我们发现年轻组 EGFR 突变的比例（22.6%比 16.2%，p=0.026）和 ALK 突变的比例（4.2%比 0.5%，p<0.001）显著高于老年组。尽管年轻组中更多的是 IV 期患者（60.1%比 49.6%，p=0.002），但他们的总生存率（OS）更高（1 年：73.7%比 66.2%，p=0.043；5 年：44.4%比 33.7%，p=0.004）（中位生存时间：55 比 26 个月，p=0.002）。在 NSCLC 的组织学亚型方面，年轻组鳞状细胞癌的发生率较低（4.2%比 16.1%，p<0.001），而两组腺癌的发生率相似（76.8%比 76.5%，p=0.924）。
尽管年轻组 NSCLC 患者中 IV 期患者的比例较高，但他们的 OS 率高于老年组。这种生存获益可能归因于更高比例的 EGFR 和 ALK 突变以及相应的酪氨酸激酶抑制剂治疗。
