Advanced disease at diagnosis is more likely among younger patients with non-small cell lung cancer (NSCLC), according to data presented at the IASLC 2022 World Conference on Lung Cancer.
Researchers analyzed US data from 2010 to 2018 and found that NSCLC patients younger than 50 years of age were more likely than older patients to have stage IV disease at diagnosis.
In fact, 76% of NSCLC patients in their 20s were diagnosed with stage IV disease, compared with 40% of NSCLC patients in their 70s.
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These results suggest a need for strategies to increase the early detection of NSCLC in younger patients who are ineligible for lung cancer screening, said Alexandra Potter, of Massachusetts General Hospital in Boston, who presented the results at the meeting.
Potter explained that the objective of this study was to examine changes in disease stage and survival outcomes for patients diagnosed with NSCLC since the introduction of lung cancer screening.
The researchers analyzed data from the United States Cancer Statistics database and the National Cancer Database, looking specifically at patients aged 20-79 years diagnosed with NSCLC from 2010 to 2018.
During this period, NSCLC was diagnosed in 1328 patients in their 20s, 5682 patients in their 30s, 39,323 patients in their 40s, 202,709 patients in their 50s, 410,482 patients in their 60s, and 447,366 patients in their 70s.
The data showed that younger patients were more likely to have stage IV NSCLC at diagnosis and less likely to be diagnosed with stage I disease. The percentages of patients with stage I and IV disease by age group are outlined in the table below.
| Age group | Stage IV NSCLC | Stage I NSCLC |
| 20-29 years | 76% | 8% |
| 30-39 years | 70% | 10% |
| 40-49 years | 60% | 14% |
| 50-59 years | 52% | 19% |
| 60-69 years | 45% | 25% |
| 70-79 years | 40% | 29% |
When the researchers looked at trends over time, they found a shift toward earlier stages of disease at diagnosis among older patients but not younger patients.
The percentage of patients diagnosed with stage IV NSCLC did not change significantly from 2010 to 2018 for patients in their 20s (P =.98) or 30s (P =.99). For patients in their 40s, the percentage of those with stage IV NSCLC increased over the study period (P =.002).
For patients in their 50s, 60s, and 70s, there was a significant decrease in the percentage of patients diagnosed with stage IV NSCLC from 2010 to 2018 (P <.001 for all).
A year-over-year multivariable analysis confirmed that patients age 50 and older were more likely to be diagnosed with earlier stages of disease in more recent years.
The researchers also evaluated 5-year overall survival (OS) rates and found they were low across the age groups — 20% for patients 20-29 years, 27% for patients 30-39, 28% for patients 40-49, 27% for patients 50-59, 28% for patients 60-69, and 24% for patients in their 70s.
When the researchers looked at changes in median OS over time, they observed improvements for patients of all ages, particularly from 2014 on. The OS improvements in patients aged 20-49 years appeared to be driven by improvements among those with stage III-IV disease.
Despite these improvements, 5-year OS rates for the younger patients with stage IV disease ranged from 10% to 15%.
Reference
Potter AL, Senthil P, Mansur A, et al. Early diagnosis of lung cancer among younger vs. older adults: Widening disparities in the era of lung cancer screening. Presented at WCLC 2022. August 6-9, 2022. Abstract 2518.
