Bronchogenic carcinoma in young patients

Background and Objectives: Some investigators have suggested that lung canc er in young patients has a more aggressive course and poorer prognosis than lung cancer in older patients. Methods: A retrospective review is presented of patients less than 40 years of age with bronchogenic carcinoma treated at Roswell Park Cancer Institut e between 1984 and 1994, with comparison to a cohort of patients treated in the previous decade. Results: There were 76 patients (41 male and 35 female). Mean age was 35 ye ars (range, 26-39). Adenocarcinoma in 33 patients (43%) and undifferentiate d large-cell carcinoma in 22 patients (29%) were the predominant histologic types. Stage ma or greater disease was present in 63 (83%) patients. Treat ment consisted of chemotherapy (55 patients), radiation therapy (54 patient s), and surgery (33 patients). Surgical procedures included pneumonectomy ( 14 patients), lobectomy (11 patients), wedge resection (1 patient), and tho racotomy only for unresectable disease (7 patients). Operative mortality wa s 6% (two patients who had radical pneumonectomy for T4 cancer). Median sur vival for the entire group of patients was 10.4 months, and 5-year survival was 8%. Univariate analysis identified acute presentation (P = 0.02), no r esection (P = 0.0001), and higher stage (P = 0.0001) as negative prognostic factors. On multivariate analysis, stage of disease was the only independe nt predictor of survival (P = 0.005). Resectability was slightly higher (34 %, 26/76, vs. 21%, 19/89; P = 0.06) and survival was marginally better (med ian 10.4 vs. 7.5 months; P = 0.05) than that seen at our institution in the previous decade. Conclusions: Young patients with lung cancer often have advanced disease at the time of presentation. Nevertheless, they should be treated in accordan ce with standard stage-specific treatment guidelines. J. Surg. Oncol. 1999: 71:29-31. (C) 1999 Wiley-Liss.