40岁以下青年人肺癌的临床病理特征和预后

目的　探讨 <4 0岁青年人肺癌的临床病理特征及预后 ,并与≥ 4 0岁的中老年人肺癌进行比较。方法　对 12 9例青年人肺癌 (青年组 )以及随机选择的 14 0例中老年人肺癌 (中老年组 )进行回顾性分析 ,比较两组临床病理特征和生存期。结果　青年组与中老年组相比 ,青年组女性患者比例高 (P =0 .0 37) ,平均症状持续时间长 (4 .7个月 ,P <0 .0 0 1) ,误诊率高 (6 5 .1% ,P <0 .0 0 1) ,平均误诊时间长 (5 .6个月 ,P <0 .0 0 1) ,以腺癌为主要病理类型 (5 4 .3% ,P <0 .0 0 1) ,癌细胞分化差 (6 9.5 % ,P <0 .0 0 1) ,诊断时晚期多 (74 .4 % ,P <0 .0 0 1) ,接受综合治疗的比例高 (94 .6 % ,P <0 .0 0 1) ,因远处转移而致治疗失败者的比例高 (6 4 .7% ,P =0 .0 2 )。两组总的中位生存期和 5年生存率差异无显著性 (P =0 .2 889) ,但Ⅰ期和Ⅱ期中 ,青年组中位生存期及 5年生存率优于中老年组 (P =0 .0 4 95 )。两组肿瘤家族史及吸烟史差异无显著性。结论　青年人肺癌的临床病理特征明显不同于中老年人肺癌 ,但生存期相似。将青年人肺癌定义为“青年型肺癌”有临床实际意义。

Clinico-pathologic and prognostic studies on lung adenocarcinoma patients under 40 years of age

OBJECTIVE: To study whether the clinico-pathologic characteristics and survival of young lung cancer patients < 40 years of age differ from those of lung cancer patients >or= 40 years of age. METHODS: Retrospective analysis was carried out to compare the clinico-pathologic features and survival of 129 young patients (young group) with those of 140 randomly selected older ones (elderly group). RESULTS: The young group, when compared with the older group, had more female (P = 0.037), longer mean duration of symptoms (4.7 m vs 2.5 m, P < 0.001), higher misdiagnostic rate (65.1% vs 24.3%, P < 0.001) with longer mean duration of misdiagnosis for the misdiagnosed patients (5.6 m vs 2.5 m, P < 0.001), more adenocarcinoma (54.3% vs 42.1%, P < 0.001), higher pathologic grade (69.5% vs 36.0%, P < 0.001), more advanced-stage diseases at diagnosis (74.4% vs 45.7%, P < 0.001), more patients receiving combined-modality treatment (94.6% vs 62.1%, P < 0.001) and more distant failures as initial relapse (64.7% vs 50.6%, P = 0.02). The median survivals and 5-year survival rates were better in patients with stage I-II disease in the young group than the older group (54 m vs 33 m and 46.2% vs 25.0%, P = 0.0495), even though the overall median survivals and 5-year survival rates were similar in either group (11 m vs 14 m and 8.3% vs 11.9%, P = 0.2889). There was no difference in family or smoking history (P = 0.227 and 0.171). CONCLUSION: Younger patients with lung cancer present difference in clinico-pathologic features from the older ones, but the survivals of the two groups are similar. To define younger lung cancer as "the younger type of lung cancer" may have a practical clinical significance.