Lee Michelle H, Qureshi Muhammad Mustafa, Suzuki Kei, Everett Peter, Tapan Umit, Mak Kimberley S
Hematology and Oncology Section, Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
Department of Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA.
J Thorac Dis. 2022 Aug;14(8):2880-2893. doi: 10.21037/jtd-22-210.
Small cell lung cancer (SCLC) in patients <50 years old has unique socioeconomic and clinical implications. We aimed to examine the demographics, treatment patterns, and survival of young patients with SCLC and compared them to older adults.
The National Cancer Database (NCDB) was queried to identify SCLC cases diagnosed from 2004 to 2016. Patients were divided into three age groups: ≥18-<50, ≥50-<70, and ≥70 years. Patient characteristics were evaluated for survival within each age group. Kaplan-Meier and Cox regression analyses were used to assess survival.
Of the 172,453 evaluated SCLC patients (median age 66 years), 8,792 were ≥18-<50 years old. Compared to the older groups, patients under 50 were more likely to be Black, uninsured or on Medicaid, have household income <$30,000, and present with stage III or IV disease (P<0.0001 for all). While young patients were more likely to receive guideline-concordant care (GCC), the hazard of death increased to 1.96 (95% CI: 1.80-2.14; P<0.0001) with receipt of nonstandard therapy. Private insurance, female gender, non-White race, Hispanic ethnicity, and higher income were associated with better survival. The youngest cohort had significantly better survival overall when compared to the older patients (P<0.0001), but the survival advantage was reduced with the advancing stage.
SCLC patients under 50 years old represent a socioeconomically disadvantaged group with advanced disease at presentation. Despite having fewer comorbidities and being offered guideline-concordant treatment, younger patients with SCLC have only marginally better survival than older patients in advanced stages.
年龄小于50岁的小细胞肺癌（SCLC）患者具有独特的社会经济和临床意义。我们旨在研究年轻SCLC患者的人口统计学特征、治疗模式和生存率，并与老年患者进行比较。
查询国家癌症数据库（NCDB）以确定2004年至2016年诊断的SCLC病例。患者分为三个年龄组：≥18-<50岁、≥50-<70岁和≥70岁。评估每个年龄组患者的生存特征。采用Kaplan-Meier法和Cox回归分析评估生存率。
在172,453例接受评估的SCLC患者（中位年龄66岁）中，8,792例年龄≥18-<50岁。与老年组相比，50岁以下患者更可能为黑人、未参保或参加医疗补助计划、家庭收入低于30,000美元，且表现为III期或IV期疾病（所有P<0.0001）。虽然年轻患者更可能接受符合指南的治疗（GCC），但接受非标准治疗时死亡风险增加至1.96（95%CI：1.80-2.14；P<0.0001）。私人保险、女性、非白人种族、西班牙裔和较高收入与较好的生存率相关。最年轻的队列总体生存率明显优于老年患者（P<0.0001），但随着疾病分期进展，生存优势降低。
50岁以下的SCLC患者是一个社会经济上处于不利地位的群体，就诊时疾病已处于晚期。尽管合并症较少且接受了符合指南的治疗，但年轻SCLC患者在晚期的生存率仅略高于老年患者。
