Title: DIFFERENCES IN CLINICAL CHARACTERISTICS, HISTOLOGIC PROFILES, AND OUTCOMES BETWEEN YOUNGER AND STANDARD PATIENTS WITH NON-SMALL CELL LUNG CANCER
Abstract: SESSION TITLE: Lung Cancer Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Lung cancer is the leading contributor to cancer-related mortality worldwide and the second most common etiology in India. Recently, growing interest has been directed towards the development of Non-Small Cell Lung Cancer (NSCLC) among young patients. Given the large volume of patients in India, a comparative analysis between NSCLC patients 40 years or younger and those of standard age at a major public referral center would provide insight into this uncommon group. METHODS: NSCLC patients who were accessioned within the Lung Cancer Clinic (LCC) database of the All India Institute of Medical Sciences (AIIMS) – Delhi between January 2008 and December 2019 were reviewed. Patients 40 years or younger and 60 years or older were selected and defined as young and standard patients, respectively. Baseline clinical characteristics, histologic profiles, and treatments administered were compared between groups using chi-square and Mood’s median test. Progression-free survival and overall survival were evaluated using a multivariate Cox proportional hazards model. RESULTS: Following database review, 154 young patients and 1058 standard patients with mean ages of 35.2 (SD 4.6) and 66.5 (SD 5.9) years, respectively, were selected for inclusion. In regard to baseline clinical characteristics, young patients were more likely to be female (30.0% vs. 14.5%, p < 0.001), attend secondary education (46.1% vs. 37.6%; p = 0.420), and retain a more independent performance status upon presentation (64.1% vs. 45.9%; p < 0.001) compared to standard patients. Young patients shared a markedly lower median smoking index (36 [0 – 300] vs. 600 [300 – 800], p < 0.001). In regard to disease-specific variables, young patients were more frequently diagnosed with adenocarcinoma (53.9% vs. 36.5%, p < 0.001), and 12 young patients were uniquely diagnosed with adenoid cystic carcinoma. Rates of stage IV disease at presentation were higher among young patients (78.0% vs. 63.0%, p < 0.001). In regard to treatment, young patients were more likely to undergo surgery or receive radiation therapy (12.3% vs. 7.3%, p = 0.030), but no differences in rates of systemic therapies administered or response to systemic therapies were observed. Based upon the multivariate Cox proportional hazards model, no differences in survival were identified. CONCLUSIONS: Within the Indian context, young NSCLC patients are frequently diagnosed with adenocarcinoma and advanced disease. The lower smoking index among young patients suggests that other factors are contributing to the development of NSCLC. Despite better performance status among young patients, outcomes between young and standard patients are not different. CLINICAL IMPLICATIONS: Younger patients without significant smoking history may harbor advanced NSCLC. Clinicians should maintain high clinical suspicion for lung cancer among patients with unexplained symptoms despite favorable demographics. DISCLOSURES: No relevant relationships by Avneet Garg, source=Web Response No relevant relationships by Randeep Guleria, source=Web Response no disclosure on file for Vijay Hadda; No relevant relationships by Hariharan Iyer, source=Web Response No relevant relationships by Deepali Jain, source=Web Response No relevant relationships by Karan Madan, source=Web Response no disclosure on file for Anant Mohan; No relevant relationships by Vishal Vashistha, source=Web Response