Abstract
OBJECTIVE: We investigated clinicopathologic characteristics, overall survival (OS), and locoregional recurrence-free survival of young surgical patients with non-small cell lung cancer. METHODS: Retrospective review of an institutional database of patients aged 50 years or younger undergoing resection for non-small cell lung cancer between January 1995 and March 2022. A control group of patients older than age 50 years was selected by stratified random sampling. Relevant characteristics were compared with Wilcoxon rank sum,χ,(2) and Fisher exact tests. Propensity-score weighting was used to control for confounders. OS and locoregional recurrence-free survival were analyzed with Kaplan-Meier and Cox proportional hazards regression. RESULTS: We identified 196 patients aged 50 years or younger and 232 patients older than age 50 years. Median age was 46 years (interquartile range, 43-49 years) in the younger group and 69 years (interquartile range, 63-74 years) in the older group. Younger patients were more often women, non-White, and with fewer comorbidities. They more often presented with symptoms, stage III or IV disease, and more often received neoadjuvant therapy. In unweighted analysis, younger patients showed superior OS (log-rank P < .0001). After propensity score weighting for procedure type, histologic type, Charlson Comorbidity Index, and smoking status, there was no significant difference in OS at 5 years between younger and older groups (70.62% vs 72.99%; weighted log-rank P = .084). Younger patients showed superior OS (weighted log-rank P = .0006) and locoregional recurrence-free survival (weighted log-rank P = .017) for clinical stage I, but not any other stage. lymphovascular invasion was an independent risk factor for worsened OS and locoregional recurrence-free survival across ages. CONCLUSIONS: Recognizing lung cancer as a differential diagnosis for patients aged 50 years or younger is crucial because this group shows superior outcomes for stage I disease. Lymphovascular invasion is an independent prognostic risk factor across age groups.