40岁以下年轻肺癌患者的回顾性分析

Retrospective analysis of young lung cancer patients under the age of 40 years

目的探讨年轻成人肺癌发病率的生物学规律和临床病理特征。方法回顾性选取2012年1月至2013年10月间上海市胸科医院收治的年龄<40岁的65例肺癌患者,统计其临床基线特征、肿瘤转移部位、基因状态、治疗方式及与预后的关系。结果纳入65例患者,58例患者(89.2%)表示从未吸烟,女性42例(64.6%);腺癌50例,鳞癌8例,小细胞7例;病理分期:Ⅰ期6例,Ⅱ期7例,Ⅲ期17例,Ⅳ期35例;初诊时发生肿瘤转移38例,最常见的为骨转移16例(42.1%),其次为胸膜转移和肺转移,各13例(34.2%);42.1%的患者合并多处转移,26.3%患者为局限在胸腔转移;40例患者驱动基因阳性,其中EGFR阳性36例,ALK阳性4例,未发现ROS1阳性患者。29例患者接受第一代EGFR-TKI(易瑞沙和特罗凯)和克唑替尼靶向治疗。患者年龄、病理类型、分期、吸烟、基因情况均与生存时间密切相关(均P<0.05)。结论年轻成人肺癌患者有独特的生物学特征,腺癌和驱动基因突变阳性居多,个体化靶向治疗可提高生存率,推荐基因检测;但临床多为初诊Ⅳ期患者,给远期生存带来很大挑战。

Objective To discuss biological mechanism and clinical and pathologic features of incidence of lung cancer in young adults.Methods Retrospective analysis was performed on lung cancer patients aged less than 40 years at Shanghai Chest Hospital from January 2012 to October 2013.The baseline characteristics,metastatic sites,genetic status,therapies and prognosis were analyzed.Results A total of 65 patients were enrolled,of whom 58(89.2%)had no previous history of smoking.Forty-two patients(64.6%)were female.Fifty patients had adenocarcinoma,8 patients had squamous cell carcinoma and 7 patients had small cell carcinoma.Pathologic staging showed 6 patients had stageⅠlung cancer,7 patients had stageⅡlung cancer,17 patients had stageⅢlung cancer,and 35 patients had stageⅣlung cancer.Bone metastases occurred in 38 patients at the initial diagnosis.The most common metastases were bone metastases which occurred in 16 patients(42.1%)followed by pleural and pulmonary metastases which occurred in 13 patients(34.2%).Multiple metastases occurred in 42.1%patients.Thoracic metastasis occurred in 26.3%patients.The driver gene was positive in 40 patients,of which 36 patients had positive EGFR and 4 patients had positive ALK.No patient Positive was found to have ROS1.Twenty-nine patients received targeted therapy with first generation EGFR-TKI(gefitinib and erlotinib)and crizotinib.Age,types of pathology,staging,smoking and gene were associated with the overall survival of lung cancer patients.Conclusion Young adults with lung cancer have unique biological characteristics.Most of them had adenocarcinoma and positive driver gene mutations.Individualized targeted therapy may improve survival.Genetic testing should be recommended.However,most patients are newly diagnosed with stage IV lung cancer,which brings great challenges to long-term survival.