Lung cancer in patients under age 40

A retrospective review of patients < 40 years (n = 91) seen at the Dana-Far ber Cancer Institute and Brigham and Women's Hospital from January I, 1983- January 1, 1993 was carried out. Of 91 patients, there were 43 men and 48 w omen with a median age of 36 years (range 28-39). Eighty percent of patient s were cigarette smokers for a tnedian of 25 pack years (range 2-68). Ninet y-one percent were symptomatic at presentation. The ECOG performance status (PS) was 0 or 1 in 83%.. At the time of diagnosis 15% had stage I/II, 17% stage IIIA, 22% stage IIIB and 45% stage IV disease. The most common histop athology was adenocarcinoma (46%). followed by small cell carcinoma (14%) s quamous cell carcinoma (12%), large cell undifferentiated (8%) and other ty pes (20%). The median survival for all 91 patients was 1 year with 2 and 5 year survivals of 30% and 18% respectively. Five year survival was related to stage of disease: 60% for patients with stage I. 58%, for stage II. 36% for stage IIIA, 10% L for stags 111B, and 3% for stage IV disease. Factors that had no significant effect on overall survival included gender, histolo gic subtype. degree of differentiation, presence or absence of symptoms, an d sites of metastases. Factors that adversely affected survival by univaria te analysis included advanced stage of disease, poor PS. duration of sympto ms for more than 3 months, and 5% or greater body weight loss. By multivari ate analysis only stage (P < 0.001) and weight loss (P = 0.02) affected sur vival. This data plus results of other published studies show that young pa tients under age 40 with lung cancer. compared to the more common older pat ients, have an increased percentage of women, have a longer duration of sym ptoms, more often have adenocarcinoma with lower frequency of squamous cell carcinoma and sometimes small cell carcinoma, and more often present with advanced disease. Despite these differences, overall patient survival remai ns poor and is similar to that of older patients. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.