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Rachel Leo, BA



Research Staff




Thoracic Surgery


Rachel Leo*, Evert Sugarbaker, Anupama Singh, Ali Basil Ali, Vivian Nguyen, Sangmin Kim, Rafael R. Barcelos, Miles McAllister, Scott J. Swanson

Principal Investigator

Scott J Swanson


Clinicopathology and Survival for Young Lung Cancer Patients Undergoing Surgical Treatment


With one of the lowest 5-year survival rates, non-small cell lung cancer (NSCLC) is the most common type of lung cancer, and it primarily afflicts the elderly. Incidence of NSCLC in patients 50 years-old and younger is relatively low, yet studies have demonstrated more advanced tumors and more aggressive pathologic characteristics in this population. As early detection and surgical intervention are crucial for improved oncologic control and survival, pre-operative and surgical characteristics of this population warrant analysis. We queried our institutional database for patients who underwent curative lung resection for NSCLC from 1/1995-1/2023. 186 patients ≤ 50 years-old (younger group, median age 46 [IQR 43-48] years) and a stratified random sample of 234 patients > 50 years-old (older group, median age 69 [IQR 63-74] years) were selected. Demographics, clinicopathologic disease characteristics, and time to death or locoregional recurrence were compared between the older and younger group. Younger patients were more likely to be non-White, (15.2% vs. 5.2%, p<.01) female (72% vs 58%, p<.01), never-smokers (31% vs. 12%, p<.001). Younger patients were more likely to present with symptoms (51% vs. 24%, p<.001) and with Stage III-IV NSCLC (19% vs 9%, p<.001). Conversely, patients in the older cohort were more likely to receive an incidental lung cancer diagnosis. The distribution of the types of symptoms at presentation were not significantly different between groups. While younger patients presented with more advanced cancer stages, they more often received neoadjuvant therapy (20% vs. 8.1%, p<.001) and had improved survival and locoregional control when compared to the older control group (p<.01).

Clinical Implications

In our analysis, younger patients who underwent surgical resection of NSCLC exhibited improved disease-free survival while presenting with later-stage cancer; however, this may be explained by a higher rate of neoadjuvant therapy in the younger group. While the guideline for annual lung cancer screening is limited to individuals aged 50 and above, it is essential to identify risk factors of patients under 50 who don’t meet the screening criteria. Our findings indicate that lung cancer patients who are 50 and younger are more often female, non-White, and never-smokers. They are more likely to present with common lung cancer symptoms such as fatigue, cough, and chest pain and more likely to have advanced-stage NSCLC. Our results underscore the importance of considering lung cancer as a potential differential diagnosis in young patients with an emphasis on female, racial minority patients who present with common lung cancer symptoms.