To investigate long-term outcomes and develop a risk model for pathological multi-station N2 (pN2b) in patients who underwent upfront surgery for clinical single-station N2 (cN2a) non-small cell lung cancer (NSCLC). From 2006 to 2018, 547 patients who had upfront surgery for suspected cN2a NSCLC underwent analysis. A risk model for predicting pN2b metastasis was developed using preoperative clinical variables via multivariable logistic analysis. Among 547 clinical cN2a NSCLC patients, 118 (21.6%), 58 (10.6%), and 371 (67.8%) had pN0, pN1, and pN2. Among 371 pN2 NSCLC patients, 77 (20.8%), 165 (44.5%), and 129 (34.7%) had pN2a1, pN2a2, and pN2b. The 5-year overall survival rates for pN2a1 and pN2a2 were significantly higher than for pN2b (p = 0.041). Histologic type (p < 0.001), age ≤ 50 years (p < 0.001), preoperatively confirmed N2 metastasis (p < 0.001), and clinical stage IIIB (vs. IIIA) (p = 0.003) were independent risk factors for pN2b metastasis. The risk scoring system based on this model demonstrated good discriminant ability for pN2b disease (area under receiver operating characteristic: 0.779). In cN2a NSCLC patients, those with multiple N2 metastases indicate worse prognosis than those with a single N2 metastasis. Our risk scoring system effectively predicts pN2b in these patients.

Young lung cancer is a rare subgroup accounting for 5% of lung cancer. The aim of this study was to compare the causes of death (COD) among lung cancer patients of different age groups and construct a nomogram to predict cancer-specific survival (CSS) in young patients with advanced stage.

Lung cancer patients diagnosed between 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and stratified into the young (18-45 years) and old (> 45 years) groups to compare their COD. Young patients diagnosed with advanced stage (IVa and IVb) from 2010 to 2015 were reselected and divided into training and validation cohorts (7:3). Independent prognostic factors were identified through the Fine-Gray's test and further integrated to the competing risk model. The area under the receiver operating characteristic curve (AUC), consistency index (C-index), and calibration curve were applied for validation.

The proportion of cancer-specific death (CSD) in young patients was higher than that in old patients with early-stage lung cancer (p < 0.001), while there was no difference in the advanced stage (p = 0.999). Through univariate and multivariate analysis, 10 variables were identified as independent prognostic factors for CSS. The AUC of the 1-, 3-, and 5-year prediction of CSS was 0.688, 0.706, and 0.791 in the training cohort and 0.747, 0.752, and 0.719 in the validation cohort. The calibration curves demonstrated great accuracy. The C-index of the competing risk model was 0.692 (95% CI: 0.636-0.747) in the young patient cohort.

Young lung cancer is a distinct entity with a different spectrum of competing risk events. The construction of our nomogram can provide new insights into the management of young patients with lung cancer.

The surgical outcomes for younger patients with non-small cell lung cancer (NSCLC) remain uncertain. The aim of this study was to investigate the clinical features long-term survival outcomes in younger individuals with NSCLC following surgery.

We queried the Surveillance, Epidemiology, and End Results database from 2010 to 2017, selecting all pathologically confirmed NSCLC cases that underwent cancer-directed surgery. Younger patients were defined as those aged 18-50 years, while older patients were 51-80 years. Propensity score matching (PSM) was implemented to mitigate selection bias. Overall survival (OS) and lung cancer-specific survival (LCSS) were compared using the Kaplan-Meier method.

Among the 33 586 treated surgically patients, 2223 (6.6%) were young. Compared to the older group, younger patients had a higher frequency of female gender, non-white ethnicity, carcinoid tumors, stage IV disease, pneumonectomy, and postoperative adjuvant therapies. The 5-year OS rates were significantly higher for younger patients (79.3% vs. 62.0%; p < 0.001), as were the 5-year LCSS rates (82.4% vs. 71.8%; p < 0.001). Post-PSM, younger patients consistently demonstrated significantly better OS and LCSS. Further stage-specific analysis revealed significantly improved 5-year OS rates at each stage and superior 5-year LCSS for stages I-II among younger patients. However, there was no statistically significant difference in LCSS for stages III-IV.

Overall, younger patients with NSCLC treated surgically exhibit superior OS and LCSS compared to their older counterparts, although no statistically significant difference in LCSS for stages III-IV was observed between the two age groups.

Lung adenocarcinoma (LUAD) is a familiar lung cancer with a poor prognosis. This study was meant to determine whether there are differences in survival between younger and older patients with early-stage LUAD because of the rise in the incidence of LUAD in young individuals over the previous few decades. We analysed the clinical, therapeutic and prognostic features of a cohort (2012-2013) of 831 consecutive patients with stage I/II LUAD who underwent curative surgical resection at Shanghai Pulmonary Hospital. Propensity score matching (PSM) was performed for age, sex, tumour size, tumour stage and therapy in a 2:1 ratio between the two groups without taking gender, illness stage at operation or decisive treatment into account. Following PSM analysis to create a 2:1 match for comparison, the final survival study included 163 patients with early-stage LUAD <50 years and 326 patients ≥50 years. Surprisingly, younger patients were overwhelmingly female (65.6%) and never smokers (85.9%). There were no statistical differences between the two groups in terms of the overall survival rate (P = 0.067) or time to advancement (P = 0.76). In conclusion, no significant differences stood out between older and younger patients with stage I/II LUAD regarding overall and disease-free survival rates. Younger patients with early-stage LUAD were more likely to be female and never smokers, which suggests that risk factors other than active smoking may be responsible for lung carcinogenesis in these patients.

This study aims to investigate the molecular properties and factors of lung cancer in young patients aged 18-45 years, affecting survival in patients with pulmonary adenocarcinoma.

Patients aged between 18 and 45 years who were diagnosed with lung adenocarcinoma in our hospital between January 2015 and December 2019 and their tumoural mutations were studied and included in this study and then reviewed retrospectively from the hospital records.

At the time of diagnosis, 71 (3.57%) of 1985 primary lung cancer patients were 45 years old, and 42 (59.2%) male and 29 (40.8%) female patients with a mean age of 39.9 were evaluated. Most of the patients were diagnosed with advanced-stage lung cancer, 55 (77.5%) of them were in stage IV. PET CT showed that the standard intake value (SUV) of 11.1 tended to be high. Multiple organ metastases were detected in 57 patients (80.3%). EGFR (epidermal growth factor receptor) mutation was positive in 13 patients (18.3%), ALK (anaplastic lymphoma kinase) mutation was positive in 13 patients (18.3%) and ROS (c-ros) mutation oncogene was positive in 2 (2.8%) patients. Surgical operation was performed in 21 (29.6%), radiotherapy was given to 29 (40.8%), chemotherapy to 48 (67.6%) and targeted therapy to 22 (31.0%) patients. The mean overall survival of the patients was 16 months. Within 1 year, 41 (57.7%) patients died.

In our study, significant efficacy of age, gender distribution, smoking, metastasis, ALK positivity, presence of chemotherapy, targeted therapy and surgical treatment was observed in young adenocarcinoma patients. The molecular properties of lung adenocarcinoma in young patients differ from those in the general population, and major driver genes are major factors influencing tumour differentiation and prognosis. In our study, we aimed to explain the molecular properties and results of pulmonary adenocarcinoma. In the future, we will provide constructive recommendations for the prevention and treatment of young patients.

To explore the epidemiological characteristics and prognosis of lung cancer in patients aged under 45 years old in northern China. The population-based database about lung cancer cases aged under 45y selected form the Hebei Provincial Cancer Registry Center from 2010-2015. Mortality data of young death from 1973 to 1975, 1990 to 1992, and 2004 to 2005 were extracted from the national retrospective survey of death. Mortality rates were calculated by the mortality database above in this analysis. Consecutive, 954 non-selected younger patients (< 45 years) and 2261 selected older patients (≥ 45 years) with pathologically diagnosed lung cancer treated at the Fourth Hospital of Hebei Medical University were included as the hospital-based database. Epidemiological, treatment outcomes and prognosis status from 2010 to 2017 were documented. A comparison with younger and older patients was also made. Multivariate analysis with young lung cancer patients was calculated by Cox regression model. The younger lung cancer mortality rate tended to slightly increase in Hebei Province, from 1.04 per100 000 in 1973 to 2.01 per 100 000 in 2015, but the PDR tended to decrease over the last 40 years. There were 954 younger and 2261 older lung cancer patients included in the hospital-based database. The proportions of patients who were female (50.84% vs 34.85%), family history of cancer (12.37% vs 6.32%), advanced stage at diagnosis (65.46% vs 60.77%) and adenocarcinoma (65.27% vs 61.11%) were relatively higher in the younger group than in the older group. The median OS were 23.0 months and 27.0 months between younger and older, the OS difference existed between the two groups (P = 0.001). In the younger patients, Cox regression showed that a family history of cancer, symptoms at diagnosis, pathology, stage at diagnosis and surgery were confirmed as independent factors affecting the prognosis. Mortality rates among younger lung cancer patients showed an increasing trend in northern China. The younger account for small but have unique characteristics, with higher proportions of female, family history of cancer, adenocarcinoma and advanced stages than the older group and had a trend of worse OS.

Lung cancer (LC) is still one of the most frequent cancers with a high related mortality. Their prognosis is directly proportional to the stage at the time of diagnosis. Seventy percent are currently diagnosed in advanced or locally advanced stage (higher than stage III), making a cure unlikely for the majority of patients. Developments in LC treatment are significant however they do not seem to be enough to reverse the current situation, at least, in a short period of time. Despite recent advances in treatment, primary prevention and early diagnosis appear to be the key to reduce the incidence and mortality of this disease. Many countries have developed LC screening programs based on the results of clinical trials published in recent years. The aim of this paper is to review the latest results of the NEderlands Leuvens Longkanker Screenings Onderzoek and compare them with the findings of the National Lung Screening Trial. We address the question whether it is necessary to continue discussing the evidence regarding LC screening. In both trials, there is a clear impact on LC mortality but, with a modest reduction in over all mortality. Undoubtedly, the benefit of screening can be expected to grow as low-dose computed tomographys are performed over longer periods of time.

Non-small cell lung cancer (NSCLC) is a public health problem that usually affects the elderly. Currently and for some years now, this disease is increasingly affecting the young population. The purpose of this study was to analyze the features of NSCLC in young subjects and to assess survival as well as the various prognostic factors.

We conducted a retrospective study of all patients under the age of 50 years treated in the Department of Pneumology at the Fattouma Bourguiba University Hospital, Monastir for NSCLC. Survival and prognostic factors have been analyzed according to Kaplan Meier method.

The average age of patients was 43.8 ± 5.29 years. The most common histological type was lung adenocarcinoma (66.1%). NSCLC was discovered at an advanced or metastatic stage in 79.7% of cases. The median overall survival was 8 ± 0.72 months. Univariate analysis showed that survival was significantly influenced by patients' general status, assessed according to the "Performance Status (PS)" index of the World Health Organization on admission, tumor stage and CRP concentrations. Multivariate analysis was performed, which enabled us to use PS index ≥ 2 and high CRP concentrations as factors of poor prognosis.

Despite the therapeutic progress, prognosis in young subjects with NSCLC is poor. Early diagnosis and management can improve survival in these patients.

Lung cancer is one of the most common malignant tumors in the world and mainly occurs in elderly patients, but rarely in young patients. The purpose of this retrospective study was to examine the clinicopathological features and prognosis of lung cancer patients aged 30 years and younger.

Patients aged 30 years and younger with lung cancer admitted to our center from November 2013 to October 2018 were retrospectively identified. Data included sex, age, smoking history, family history of cancer, high resolution computed tomography results, size and location of tumors, histology of tumors, lymph node status, stage of tumors, treatment methods and prognosis of patients.

The patient group included more females (56.3%) than males (43.7%) among lung cancer patients aged 30 and younger. Some patients had a history of tobacco inhalation and family cancer (17.5% and 22.3%, respectively). The most common tumors were in the left lower lobe (27.2%). Nearly half (49.5%) of the patients had pathological adenocarcinomas and 59.3% of the patients were showed early clinical stage and had no lymph node metastasis. All patients received surgical treatment; 47.1% received lobectomy and only 17.9% received adjuvant therapy such as radiotherapy, chemotherapy or targeted therapy after operation. Only seven (7.4%) of the successful follow-up patients died. Local recurrence occurred in two cases and distant metastasis in six cases.

The main clinicopathological type of lung cancer in young lung cancer patients aged 30 years and younger is adenocarcinoma, and most cases were at the early stage. Surgical treatment based on lobectomy is still the main treatment method and the prognosis of these patients is very good. Early screening of lung cancer should be actively promoted for young people.

The reported age-specific survival rates of lung cancer patients have been largely inconsistent. Management strategies for younger patients and treatment outcomes are not well characterized.

Out of the 4,697 lung cancer patients with treatment history at Tokyo Medical University Hospital between January 2000 and December 2014, 266 patients were <49 years of age. Patient characteristics were investigated, and the association of overall survival (OS) with age, sex, stage, and histological type were investigated.

The 1-, 3-, and 5-year survival rates in the ≤49 years age group were 82.9%, 64.6%, and 57.0%. Among surgical cases, the survival rate of patients in the ≤49 years age group was significantly better than that in the 50-69 and ≥70 years age groups (P=0.29 and P<0.0001, respectively). In comparison with the OS rate with clinical stages, I, II, and III (but not with clinical stage IV) in the older than 50 years age group, the rates in the ≤49 years age group were better. The 1-, 3-, and 5-year OS rates of females were higher than those of their males. The 1-, 3-, and 5-year OS rates for lung adenocarcinoma patients were higher than that of lung non-adenocarcinoma patients.

Despite the higher proportion of advanced disease, the postoperative survival rate of the younger was higher than that of the older. Aggressive multimodality treatments, including surgery, are more feasible and effective for younger patients as compared with that in older patients.

The global burden of lung cancer has been increasing over the past years, and is still a major threat to public health worldwide, leading to disabilities and premature mortality. Despite multifactorial cause, smoking remains as the major etiological factor, followed by occupational exposure to carcinogens, genetic predisposition and other concomitant diseases. In order to reduce the individual and social burden due to the direct and indirect costs related to the lung cancer treatment, accurate methods of screening are needed. Among those, x-ray with cytological analysis of sputum was first proposed. Nowadays, more sensitive methods such as low-dose computed tomography are being used to improve the early detection. In the future, molecular biomarkers may complement low-dose computed tomography and improve the robustness of early lung cancer detection.

Non-small cell lung cancer (NSCLC) prognosis and risk of lymph node positivity (LN+) are reference points for reasonable treatments. The aim of the current study was to investigate the effect of age on LN+ and NSCLC death. Data from the Surveillance, Epidemiology, and End Results (SEER) registry were used to identify 82,253 patients with NSCLC diagnosed between 1988 and 2008. All the patients underwent standard lung cancer surgery with lymph node examination. Demographic and clinicopathological parameters were extracted and compared among each age group. Impact of age on LN+ and NSCLC death was evaluated by the Cochran-Armitage trend test and logistic univariate and multivariate analyses for all T stages. Overall, 22,711 (27.60%) patients of the entirety had lymph node metastasis and 28,968 (35.22%) patients died of NSCLC within 5 years. With the increase in age, LN+ rates decreased regardless of T stages (P<0.001), whereas NSCLC-specific mortality increased in stages T1-T3 (P<0.001). Controlling other covariates in multivariable logistic regression, age remained an independent risk factor for LN+ in all T stages (P<0.05) and in stages T1-T3 (P<0.05). Our SEER analysis demonstrated a higher rate of LN+ and lower mortality in younger patients with NSCLC, after accounting for other covariates.

Non-small cell lung cancer (NSCLC) in young adults is a rare but devastating illness with significant socioeconomic implications, and studies of this patient subgroup are limited.

This study employed the National Lung Cancer Audit to compare the clinical features and survival of young adults with NSCLC with the older age groups.

A retrospective cohort review using a validated national audit dataset.

Data were analysed for the period between 1 January 2004 and 31 December 2011. Young adults were defined as between 18 and 39 years, and all others were divided into decade age groups, up to the 80 years and above group. We performed logistic and Cox regression analyses to assess clinical outcomes.

Of a total of 1 46 422 patients, 651 (0.5%) were young adults, of whom a higher proportion had adenocarcinoma (48%) than in any other age group. Stage distribution of NSCLC was similar across the age groups and 71% of young patients had stage IIIb/IV. Performance status (PS) was 0-1 for 85%. Young adults were more likely to have surgery and chemotherapy compared with the older age groups and had better overall and post-operative survival. The proportion with adenocarcinoma, better PS and that receiving surgery or chemotherapy diminished progressively with advancing decade age groups.

In our cohort of young adults with NSCLC, the majority had good PS despite the same late-stage disease as older patients. They were more likely to have treatment and survive longer than older patients.

Orthotopic liver transplantation (OLT) is the gold standard treatment for patients with early hepatocellular carcinoma (HCC). There are concerns about the efficacy of OLT for HCC in older patients, who we hypothesized might have poorer outcomes. Therefore, we sought to examine advanced age and its impact on OLT outcomes.

The United Network for Organ Sharing database was queried for patients who underwent OLT for HCC from 1987 to 2009. Patients were divided into 3 age groups: 35 to 49 years old, 50 to 64 years old, and 65 years or older, and patient characteristics were compared. Univariate and multivariate analyses were performed to assess the impact of age on OLT outcomes.

Of 10,238 patients with OLT for HCC, 16.5% (n = 1,688) of patients were 35 to 49 years old, 67.8% (n = 6,937) were 35 to 49 years old, and 15.8% (n = 1,613) were 65 years and older. By Kaplan-Meier method, the 50- to 64-year-old age group had the highest overall survival, despite having one of the highest rates of hepatitis C positivity (70%), but this group also had the lowest rate of diabetes mellitus (8.7%). The lowest overall survival was observed in the 65-year or older age group (p < 0.001). Finally, there was no difference in disease-specific survival among the age groups (p = 0.858), and patients aged 65 years and older had the highest rate of death from nonhepatic causes (17.5%).

Although OS was prolonged in younger patients who underwent OLT for HCC, there was no observed difference in disease-specific survival among the age groups. Our results suggest that carefully selected patients 65 years of age and older can derive equal benefit from OLT for HCC when compared with their younger counterparts.

The clinicopathological characteristics and surgical results of young lung cancer patients were investigated.

Seven hundred and four (6.0%) patients with lung cancer, aged up to 50 years, were enrolled from among the 11,663 patients registered in the Japanese Lung Cancer Registry Study 2004, and their clinical data were compared with those of 10,959 patients older than 50 years. This epidemiological study is based on the single year registration of surgically treated patients in the major institutes in Japan.

The 5-year overall survival rate (5Y-OS) and the 5-year lung cancer-related survival rate was 79.2%/69.0% (p<0.001) and 81.3%/76.6% (p=0.005) in the young/old groups, respectively. In the young/old groups, lobectomy and pneumonectomy was performed in 76.9%/78.0% and 5.7%/3.2%, respectively; adjuvant therapies were given preoperatively in 10.4%/4.7% (p<0.001) and postoperatively in 31.4%/24.5% (p<0.001). The proportions of patients with p-stage IIIA (18.2%) and adenocarcinoma histology (78.7%) were higher in the young group. The 5Y-OS was 94.8%/86.2% for p-stage IA (p<0.001), 87.0%/73.2% for p-stage IB (p=0.001), 61.0%/61.6% for p-stage IIA (p=0.595), 71.0%/48.4% for p-stage IIB (p=0.003), 49.6%/39.4% for p-stage IIIA (p=0.020), and 80.0%/24.8% for p-stage IIIB (p=0.012); it was 83.5%/80.7% for females (p=0.106) and 75.1%/62.3% for males (p<0.001) in the young/old groups. The postoperative survival was significantly better with all operative procedures in the young group. The 5Y-OS after recurrence was 17.9%/13.4% in the young/old groups (p=0.016). In the young group, the 5Y-OS was better in females (83.5%) than in males (75.1%, p=0.002), and for patients with adenocarcinoma (80.3%) than for those with squamous cell carcinoma (68.5%, p=0.013). Age up to 50 years was identified as an independent better prognostic factor on multivariate analysis.

The postoperative survival in lung cancer patients aged up to 50 years was better than that in patients older than 50 years.

The treatment, prognosis, and outcomes of young lung cancer patients have not been fully explored. In addition, there is a pressing need to characterize this subgroup of patients, because there is a trend of increasing incidence in younger patients from Europe and Japan.

Consecutive, nonselected young patients (<45 years old) with pathologically diagnosed lung cancer treated at 175 qualified hospitals in the greater Shanghai area were included in this analysis. Incidence, prognostic factors, and treatment outcome of lung cancer patients from 2002 to 2006 were documented. A comparison with lung cancer patients of any age was also made.

A total of 12,380 patients with nonsmall cell lung cancer were registered. Among them, 652 patients were between 15 and 45 years old. One-year, 3-year, and 5-year survival rates of lung cancer patients younger than 45 years were 49.87%, 26.68%, and 23.12%, respectively. TNM stage, treatment hospital (tertiary vs community hospital), sex, and cancer histology were confirmed as independent prognostic factors. Compared with lung cancer patients of any age in Shanghai, the percentage of adenocarcinoma in the young male subgroup was significantly higher (63.77% vs 43.19%, P<.001). Interestingly, median survival time of young lung cancer patients was similar with that of lung cancer patients of any age, but was significantly shorter than the median survival of middle-aged patients (45-60 years old).

Median survival of the middle-aged group (45-60 years) was significantly longer than the young group (<45 years) and the old group (>60 years). Therefore, aggressive treatment modalities should be strongly considered for young lung cancer patients.

Biobanks may play a pivotal role in lung cancer patients' management, research, and health policy. The Nancy "Centre of Biologic Resources" analyzed the evolving profiles of operated lung cancer patients and their management over 20 years.

A total of 1259 consecutive patients operated upon from 1988 till 2007 were included. Survival rates were statistically compared before and after 1997. The parameters associated with a significant improvement of survival were determined.

After 1997, lung cancer was diagnosed at an earlier stage. For Squamous Cell Lung Cancer (SQCLC), stages IA increased from 5.4 to 19.5% and for Adenocarcinoma (ADC), stage IA increased from 9.9 to 24.7%. More women with stage I ADC were operated upon after 1997 (p = 0.01). More patients with Large Cell Lung Cancer were diagnosed recently. Recent patients received more adjuvant or neo-adjuvant chemotherapy (p < 0.001) and less radiotherapy (stage I SQCLC: p = 0.019, stage I ADC: p < 0.001). A longer overall patients' survival was observed after 1997 (chi test for SQLC and ADC independently p < or = 0.002). Among SQCLC long survivors, those at stage I-II, below 50 years, were more numerous. A longer survival was associated with early stage in ADC patients. Stage was the single constant factor for overall outcome.

Overall and stage-adjusted survival of operated lung cancer patients has been improved in the last decade due mainly to earlier diagnosis. The generalized use of computed tomography scan, chemotherapy, and a collegial management improved patients' survival.

Controversy exists regarding the clinical characteristics, pathological findings, and prognosis of patients < 50 years of age with primary lung cancer. The medical records of 4,556 patients diagnosed with primary lung cancer between 1980 and 2004 were reviewed; of these, 305 were < 50 years old. Of 1,335 patients who were surgically treated, 122 were < 50 years old. Females were over-represented in the younger group. Younger patients had a significantly higher incidence of adenocarcinoma and large cell carcinoma, and a lower incidence of squamous cell carcinoma. The resectable rate in younger patients was significantly higher. Overall and among surgically treated patients, the survival rates of younger patients with stage 0-I disease were significantly better than those of older patients. Younger patients with early-stage primary lung cancer had a significantly better prognosis than older patients, although survival in the advanced stages was not significantly different.

This study reports on the demographic features, clinico-pathological results and prognoses of patients aged less than 36 years diagnosed with non-small cell lung cancer (NSCLC).

This is an observational study of patients with primary NSCLC who had a surgical procedure at a tertiary thoracic surgery centre in Turkey. Data collected were age, gender, history of smoking, symptoms, postoperative histopathological diagnosis, stage, surgical procedure and survival.

Of the 31 patients in the study, 27 were male (87%) and the median age was 32 years (10-35 years). Nineteen patients were smokers (61.2%). The most common presenting symptom was cough (n = 23, 67.7%). Histopathological diagnosis was squamous cell carcinoma (SCC, n = 17), adenocarcinoma (n = 12), lymphoepithelioma-like carcinoma (n = 1) and undifferentiated carcinoma (n = 1). Staging of the 17 patients with SCC (58.8%) was stage I and II (n = 10, 58%), and stage III (n = 7, 41%). Staging of the 13 patients with adenocarcinoma was stage IV (n = 2, 16%) and stage III patients (n = 8, 66%). Follow-up data were available on 22 patients (71%) and showed a median survival of 17.2 months. Two and 5-year survival rates were 54.5% and 45.5%, respectively.

SCC comprised a relatively high proportion of NSCLC in these younger patients. Aggressive multimodality treatment may achieve satisfactory 2- and 5-year survival rates in young patients with NSCLC who usually present with advanced disease.

The aim of this study was to compare the epidemiologic, clinical, and laboratory characteristics and survival rates of younger and older patients with lung cancer. We studied 1340 patients who were histopathologically diagnosed as having lung cancer from 1990 to 2005. Based on prior reports, we defined "younger" as individuals less than 50 years old. The patients were classified into two groups: <50 years (the younger group) and >/=50 years (the older group). Of the 1340 patients, 179 (13.4%) were in the younger group and 1161 were in the older group. In the younger group, exposure to occupational risk factors was a risk factor for lung cancer, while in the older group, smoking was a risk factor. At the time of diagnosis, chest pain was more common in the younger group, while in the older group, cough, dyspnea, and hilar enlargement on chest X-ray were more frequent. The incidence of adenocarcinoma and small-cell carcinoma was greater in the younger group, while squamous cell carcinoma was more common in the older group. Metastasis rates were significantly different between the two age groups: 52.0% of the younger group presented with stage IV disease compared with 43.5% of the older group. Although fewer younger than older patients were not able to receive or rejected anticancer therapy, the overall survival was similar in both groups. These data indicate that lung cancer had different etiopathogenetic characteristics in younger patients, which may have clinical implications. By planning preventive measures based on these characteristics, more efficient use of resources can be achieved.

Bronchogenic malignancy is the number one cause of cancer deaths in both men and women worldwide. National registry-based studies have shown gender disparity in clinicopathologic characteristics and in survival. This study evaluates the risk factors and trends of lung cancer between genders.

A prospective cohort of consecutive patients with non-small cell lung cancer (NSCLC) who were carefully clinically (all underwent dedicated positron emission tomography scans) and pathologically staged with stage I, II, or III disease underwent homogenous treatment algorithms and were followed up over a period of 7 years. Primary outcomes were 5-year survival and response to neoadjuvant therapy.

There were 1,085 patients (671 men and 414 women). Groups were similar for race, pulmonary function, smoking history, comorbidities, neoadjuvant therapy, histology, and resection rates. Women were younger (p = 0.014), had a higher incidence of adenocarcinoma (p = 0.01), and presented at an earlier pathologic stage (p = 0.01) than men. The overall age-adjusted and stage-adjusted 5-year survival rate favored women (60% vs 50%, respectively; p < 0.001). Women had better stage-specific 5-year survival rates (stage I disease, 69% vs 64%, respectively [p = 0.034]; stage II disease, 60% vs 50%, respectively [p = 0.042]; and stage III disease, 46% vs 37%, respectively [p = 0.024]). Women who received neoadjuvant chemotherapy alone (n = 76) were more likely to be a complete or partial responder than men (n = 142; p = 0.025).

Despite uniform staging and treatment, the 5-year survival rate of women with stage I to III NSCLC was better than men overall and at each stage. Women are more likely to have adenocarcinoma, to present with earlier stage disease, and to be younger. Interestingly, women respond better to neoadjuvant chemotherapy.

It has been suggested that lung cancer follows a more aggressive course and has a poorer prognosis in young patients than in elderly patients. We conducted this study to determine whether the basal characteristics and survival of young patients undergoing surgical resection of lung cancer differ from those of elderly patients.

Eighty patients who underwent surgery for lung cancer at our hospital between 1989 and 2004 were divided into two groups according to age. Group 1 comprised 50 patients aged 45 years or younger and group 2 comprised 30 patients aged 70 years or older. The patients' medical records were reviewed with respect to age, gender, histological diagnosis, coexisting diseases, smoking history, postoperative staging, type of operation, and postoperative morbidity, mortality, and survival results.

The average ages were 40.2 +/- 3.77 years (range, 29-45 years) in group 1 and 72.2 +/- 2.53 years (range, 70-80 years) in group 2. The incidence of postoperative complications was significantly higher in group 2 (P = 0.02). However, the 5-year survival rates for patients who underwent surgery for non-small cell lung cancer did not differ between groups 1 and 2, at 33.3% versus 21.3%, respectively (P = 0.09).

The incidence of adenocarcinoma was higher in the young patients, whose prognosis was slightly better than that of the elderly patients. Coexisting diseases and postoperative complications were the major factors that adversely affected the prognosis of the elderly patients.

The effects of smoking on hearing loss within the context of atherosclerosis was assessed, and the statistical interaction of occupational noise evaluated. A cross-sectional study was conducted in 397 Japanese males working at a metal factory, aged 21-66 years, in a periodical health checkup. The following information was obtained: two smoking indices of smoking status and Brinkman index, occupational noise exposures and atherosclerotic risk factors (body mass index, blood pressure, serum cholesterol, hemoglobin A1c, atherosclerosis index). Hearing acuity was measured at 4 kHz using a pure-tone audiometer in a quiet room. Among the total subjects, 55 (13.9%) were identified as having hearing loss at 4 kHz, and 151 (38.0%) were currently exposed to occupational noise. When adjusted for age and occupational noise exposure, odds ratios (95% confidence intervals) of hearing loss were 3.16 (1.04, 9.62) for past smokers and 3.39 (1.05, 11.01) for heavy smokers (Brinkman index >750 cigarettes per day x number of years), compared with never-smokers. Statistical interaction of occupational noise exposure was insignificant with the association between smoking and hearing loss. When including atherosclerotic risk factors in a multiple model, there were no significant associations between hearing loss and either smoking or any other factors (i.e., occupational noise and atherosclerotic factors). Smoking was found to be associated with hearing loss beyond occupational noise exposure, and this association seemed to be masked by atherosclerotic factors, suggesting that the direction of the atherosclerotic effect on the relationship might need to be explored between smoking and hearing impairment.

To investigate the relationship between the clinical features and prognosis in young patients with lung cancer who underwent resection.

Statistical analysis was employed on sex, age, symptoms, diagnosis, treatment and prognosis, in 92 young cases younger than 40 years old among 930 cases with primary lung cancer who underwent surgery from January 1978 to December 1996.

There were 92 young patients with lung cancer, accounting for 9.89% of the total cases. They were 71 male and 21 female patients, with the ratio of 3.38:1. The histological types were 34 squamous cell carcinomas (37%), 30 adenocarcinomas (33%), 26 small cell carcinomas (28%), and two large cell carcinomas (2%). On TNM staging, there were 30 cases in stage I (32.6%), 30 in stage II (32.6%) and 32 in stage III (34.8%). Lobectomy was conducted in 54 patients (59%), pneumonectomy in 36 (39%) and wedge-shaped resection in two cases (2%). The rate of pneumonectomy in young patients was significantly higher than that of 18% in older patients (>40) with lung cancer (P<0.01). 57 patients (62%) received absolutely curative resection; 28 cases (30%), relatively curative resection; seven cases (8%), non-curative resection. The postoperative 5-year-survival was 46% (42/92), in comparison with 34% (288/838) in patients older than 40 receiving operation during the same period, with significant difference between the two groups (P<0.05). The 5-year-survivals in patients with squamous cell carcinoma, adenocarcinoma, small cell carcinoma and large cell carcinoma were 68% (23/34), 30% (9/30), 38% (10/26) and 0 (0/2), respectively. The survival in squamous cell cancer was markedly higher than in adenocarcinoma (P<0.01) and in small cell carcinoma (P<0.05). There was no significant difference between adenocarcinoma and small cell cancer. The 5-year-survivals in stage I, II and III were 63% (19/30), 53% (16/30) and 22% (7/32), respectively. There was no significant difference between stage I and II, while remarkable difference was found between stage I and III (P<0.01), and between stage II and III (P<0.05). The 5-year-survival in patients undergoing absolutely curative resection was 67% (38/57), and 14% (4/28) in patients with relatively curative resection, with significant difference (P<0.01). No patient survived longer than the 5th postoperative year in seven cases receiving non-curative resection.

Young patients with lung cancer were more often seen in male than in female. Squamous cell carcinoma accounted for the most part, no statistical difference, however, compared with adenocarcinoma and small cell carcinoma. The pneumonectomy rate in young patients was remarkably higher than that in patients older than 40. The postoperative 5-year-survival in young patients was considerably higher than in patients older than 40 who underwent surgery during the same period. Favorable prognosis was seen in patients with squamous cell carcinoma and undergoing absolutely curative resection, while worse outcome in stage III cancer.

The purpose of this document is to provide recommendations for the selection of the optimal target population for lung cancer screening trials with Spiral Computer Tomography based on an analysis of risk factors and high-risk populations. Our recommendations are to include current or ex-smokers (<5 years) with a smoking history of at least 30 years and an average consumption of at least 20 cigarettes a day. When these selection criteria are applied there is no need for a lower age cut-off. Elderly people can be included as long as their life expectancy is more than 10 years. Participants should be fit enough to undergo thoracic surgery. They may have a history of previous cancer, provided that the cancer has been curatively treated at least 5 years ago without evidence of relapse, except for breast cancer, melanoma and hypernephroma. People with an inability to lie flat, who are unable to hold their breath for 20 s, with a body weight above 140 kg, a chest CT scan within 1 year before enrolment or a previous pneumonectomy should not be invited. The inadequacy of the unit 'Pack-Years' (PY) to estimate the individual lung cancer risk is recognised, and future initiatives to develop an appropriate lung cancer risk model are encouraged.

Computed tomography (CT) and fine needle guided biopsy (FNB) are often used in the assessment of patients with lung nodules. The influence of these techniques on clinical decision making has not been quantified, especially for small solitary pulmonary nodules (SPN) where the probability of malignancy is lower. A study was undertaken to determine the effect of CT and FNB derived information on clinical decision making in patients with a solitary pulmonary nodule < or = 3 cm in diameter on initial chest radiography.

Clinical, physiological, and outcome data on 114 patients with an SPN < or = 3 cm who had subsequent thoracic CT and FNB were extracted from the records of a specialist cardiorespiratory hospital in Auckland, New Zealand. Chest radiographs and CT scans were reported according to specified criteria by a thoracic radiologist. Computer generated summary sheets were used to present cases to each of six clinicians. Each case was presented three times: (1) with clinical data and chest radiograph only; (2) with the addition of the CT report; and (3) with all data including the result of the FNB. Clinicians were asked to specify their management on each occasion and to estimate the probability of the lesion being malignant. Reproducibility was assessed by re-evaluating 24 cases 1 month later.

33 (29%) nodules were benign, 35 (31%) nodules (malignant) were resected with negative node sampling, and 46 (40%) had a non-curative outcome (radiotherapy, incomplete resection, refused therapy). Intra-clinician decision making was consistent for all three levels of clinical data (median kappa values 0.79-0.89). Agreement between clinicians on the need for surgery was lowest with chest radiography alone (kappa=0.33), rose with CT information (kappa=0.44), and increased further with the addition of the FNB data (kappa=0.57). The proportion of successful decisions on surgical intervention (against the known outcome) increased with the addition of CT reports and further with FNB reports (p=0.006, Friedman's test). The major benefit of the information added by CT and FNB reports was a reduction in unnecessary surgery, especially when the clinical perception of pre-test probability of malignancy was intermediate (31-70%). FNB data contributed most to the benefit (p<0.001). The addition of CT and FNB was cost efficient and can be applied specifically to patients with a low or intermediate probability of malignancy.

Both CT and FNB make cost effective contributions to the clinical management of SPN < or = 3 cm in diameter by reducing unnecessary operations and increasing agreement between physicians on the need for surgery.