A comprehensive comparison between young and older-age non-small cell lung cancer patients at a public referral centre in Delhi, India

Abstract

Purpose Given the increasing number of non-small cell lung cancer (NSCLC) patients in India, a comparative analysis between patients under 40 years and those of older age at a major public referral centre would provide insight into the phenotypic patterns of this group. Methods NSCLC patients who were accessioned within the lung cancer clinic database of the Pulmonary Medicine Department at the all India institute of medical sciences – Delhi between 2008 and 2019 were reviewed. Patients 40 years or younger and 60 years or older were selected and categorised as young and older patients, respectively. Baseline clinical characteristics, histologic profiles, treatments administered and survival outcomes were compared between both groups. Results Following the database review, 154 young and 1,058 older patients were selected for inclusion. Clinically, young patients were more often female (26.0% versus 14.5%, p < 0.001), retained a more independent performance status (64.1% versus 45.5%; p < 0.001) and never smoked (63.7 % versus 18.8%, p < 0.001). Regarding disease profiles, young patients were more frequently diagnosed with adenocarcinoma ( p < 0.001) and 12 young patients had adenoid cystic carcinoma. Rates of stage IV disease at presentation were higher among young patients (78.0% versus 63.0%, p < 0.001). Regarding treatment, no differences in systemic therapies administered or survival were identified. Conclusion In India, young NSCLC patients are frequently non-smokers and diagnosed with advanced disease. Despite better performance status, young patients do not share better outcomes. Efforts should be directed towards optimising intensive treatment for young patients.

Stage IV non-small cell lung cancer among young individuals: Incidence, presentations, and survival outcomes of conventional therapies

“…Therefore, the ADC histology subtype dominated in this population. No sex differences were observed in our study, which was similar to several other studies (4,9,23). Our study showed that when compared with the older cohort, younger patients were more likely to be diagnosed at advanced stages and receive aggressive treatments.…”

“…In our view, the reduced incidence might be attributed to economic development and improved living standards. Over the past few decades, poverty and geographical restraint have prevented some NSCLC patients from receiving standard cancer care services (9). Therefore, many NSCLC patients are diagnosed at advanced stages on initial examinations.…”

“…Consistent with previous studies (4, 5, 9-12, 14-16, 23), we also found that more young NSCLC patients were diagnosed with the ADC histology subtype. A possible explanation might be related to smoking: it is known that smoking is considered an important carcinogenesis factor for SCC (24, 25), and young patients are unlikely to be smokers (9,13,23). Therefore, the ADC histology subtype dominated in this population.…”

“…Previous clinical series demonstrated that young NSCLC patients are more likely to be female, to be non-smokers, to have adenocarcinoma (ADC) subtypes, and to have advanced-stage diseases than older NSCLC patients (4,5,(9)(10)(11)(12)(13)(14)(15)(16). Furthermore, the survival rate of young patients is inferior to that of older patients (9)(10)(11)13).…”

“…Previous clinical series demonstrated that young NSCLC patients are more likely to be female, to be non-smokers, to have adenocarcinoma (ADC) subtypes, and to have advanced-stage diseases than older NSCLC patients (4,5,(9)(10)(11)(12)(13)(14)(15)(16). Furthermore, the survival rate of young patients is inferior to that of older patients (9)(10)(11)13). However, these studies focused on the entire entity of young NSCLC patients, and no literature is available about the clinicopathological features and prognosis of young stage IV NSCLC patients.…”