年轻肺癌患者的临床特征和分子特征的回顾性研究

Clinical characteristics and molecular features of young Chinese patients with lung cancer

目的:探究年轻肺癌患者(≤40岁)的临床特征、分子特征和预后。方法:此回顾性研究纳入了我院2010年至2020年间279例临床资料完整的年轻肺癌患者分析其临床特征。此研究纳入我院2010年至2020年间419例进行下一代测序检测(next-generation sequencing,NGS)的年老肺癌患者(>40岁)来比较年轻组和年老组肺癌患者分子特征的差异,探讨了年龄依赖性突变频率。单变量和多变量分析用于发现晚期年轻患者的预后因素。结果:腺癌是年轻肺癌患者的主要病理亚型;大多数我国年轻患者被诊断为早期肺癌,且TNM分期与体检显著相关(P<0.001)。年轻组的EGFR突变频率明显低于年老组(P=0.047)。年轻组ALK(P<0.001)、ROS1(P<0.001)和ERBB2(P=0.001)的变异率显著高于年老组。单变量和多变量分析显示女性(HR,0.541;95%CI:0.308~0.950)(P=0.032)、吸烟史(HR,2.829;95%CI:1.083~7.389)(P=0.034)、单纯化疗(HR,3.242;95%CI:1.390~7.565)(P=0.007)和单纯分子靶向治疗(HR,2.227;95%CI:1.077~4.607)(P=0.031)是影响晚期年轻肺癌患者PFS的独立因素。结论:我国年轻肺癌患者以腺癌和早期肺癌为主。具有独特的分子特征,因此检测其分子特征并积极治疗更为有益。

Objective:To investigated the clinical characteristics,molecular features,and outcomes of young Chinese patients(≤40 years old)with lung cancer.Methods:The retrospective study enrolled 279 young patients with complete clinical data and 419 older patients(>40 years old)with next-generation sequencing detection in our institute from 2010 to 2020.We explored the age-dependent mutation frequencies by comparing the molecular features of young and elderly lung cancer patients.Univariate and multivariate analyses were applied to discover the prognostic factors for young patients.Results:Adenocarcinoma was the predominant pathological subtype of young Chinese patients.Most young Chinese patients were diagnosed with early TNM stage,which was significantly associated with physical examination(P<0.001).The EGFR mutation frequency of the younger group was significantly lower than the older group(P=0.047).The variation rates of ALK(P<0.001),ROS1(P<0.001),and ERBB2(P=0.001)in the younger group were significantly higher than in the older group.Univariate and multivariate analyses revealed that female(HR,0.541,95%CI:0.308~0.950)(P=0.032),smoking history(HR,2.829,95%CI:1.083~7.389)(P=0.034),chemotherapy alone(HR,3.242,95%CI:1.390~7.565)(P=0.007)and molecular targeted alone(HR,2.227,95%CI:1.077~4.607)(P=0.031)were independent factors influencing PFS in young patients with advanced lung cancer.Conclusion:Young Chinese patients with lung cancer were mainly adenocarcinoma and early-stage.Young Chinese patients had unique molecular characteristics,so it was more beneficial to identify their molecular characteristics and actively treat them.