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Sant M, Daidone C, Innos K, Marcos-Gragera R, Vanschoenbeek K, Barranco MR, Poch EO, Lillini R. Patterns of care and survival for lung cancer: Results of the European population-based high-resolution study. FRONTIERS IN EPIDEMIOLOGY 2023; 3:1109853. [PMID: 38455923 PMCID: PMC10910949 DOI: 10.3389/fepid.2023.1109853] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/08/2023] [Indexed: 03/09/2024]
Abstract
Objectives To investigate differences in lung cancer (LC) management and survival using data from European population cancer registries. Methods We analysed 4,602 lung cancer cases diagnosed in 2010-2013, followed-up to 2019 in five countries. Multivariable logistic regression was used to calculate the Odds Ratio (OR) of surgery for stages I-II LC or chemo- or radiotherapy for stages III-IV LC. Relative survival (RS) was estimated by the actuarial method; Relative Excess Risk of death (RER), with 95% CI, was calculated by generalized linear models. Results Diagnostic work-up was extensive for 65.9% patients (range 57%, Estonia, Portugal - 85% (Belgium). Sixty-six percent of stages I-II patients underwent surgery; compared to non-operated, their adjusted OR decreased with age and was associated with main bronchus cancer (OR vs. lobes 0.25, CI, 0.08-0.82), stage II (OR vs. stage I: 0.42, CI, 0.29-0.60), comorbidity (OR vs. absent: 0.55, CI, 0.33-0.93), country (ORs: Estonia 1.82, CI, 1.28-2.60; Belgium 0.62, CI, 0.42-0.91; Portugal 0.69, CI, 0.52-0.93).Almost half of stages III-IV patients received chemo- or radiotherapy only; the adjusted OR vs. non receiving decreased with age and was associated with unspecified cancer topography or morphology. The adjusted five-year RER increased with age and stage and was lower for women (0.78, CI, 0.72-0.86), above the reference for main bronchus cancer (1.37, CI, 1.21-1.54) and unspecified morphology (1.17, CI, 1.05-1.30). Surgery carried the lowest mortality (RS 56.9; RER 0.13, CI, 0.11-0.15) with RER above the mean in Estonia (1.20, CI, 1.10-1.30), below it in Portugal (0.88, CI, 0.82-0.93) and Switzerland (0.91, CI, 0.84-0.99). Comorbidity (1.21, CI, 1.09-1.35) and not smoking (0.68, CI, 0.57-0.81) were associated with RER. Conclusions The survival benefit of early diagnosis, allowing curative surgery, was evident at the population level. Screening for subjects at risk and adhesion to standard care should be incremented across the EU by funding better equipment and training health personnel.
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Affiliation(s)
- Milena Sant
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Caterina Daidone
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Tallinn, Estonia
| | - Rafael Marcos-Gragera
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology (ICO), Girona, Spain
- Biomedical Research Institute (IdiBGi), Girona, Spain
| | | | - Miguel Rodriguez Barranco
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Granada Cancer Registry, Granada, Spain
- Andalusian School of Public Health (EASP), Granada, Spain
| | - Ester Oliva Poch
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
- Girona Cancer Registry, Girona, Spain
- Radiation Oncology Department, Catalan Institute of Oncology Hospital Trueta, Girona, Spain
| | - Roberto Lillini
- Analytical Epidemiology and Health Impact Unit, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Pilleron S, Gower H, Janssen-Heijnen M, Signal VC, Gurney JK, Morris EJ, Cunningham R, Sarfati D. Patterns of age disparities in colon and lung cancer survival: a systematic narrative literature review. BMJ Open 2021; 11:e044239. [PMID: 33692182 PMCID: PMC7949400 DOI: 10.1136/bmjopen-2020-044239] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars. DESIGN Systematic review of the literature. DATA SOURCES We searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020. ELIGIBILITY CRITERIA We retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment). DATA EXTRACTION AND SYNTHESIS Two independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves. RESULTS Out of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer. CONCLUSIONS Although age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival. PROSPERO REGISTRATION NUMBER CRD42020151402.
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Affiliation(s)
- Sophie Pilleron
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Helen Gower
- Department of Surgery and Anaesthesia, Surgical Cancer Research Group, University of Otago, Wellington, New Zealand
| | - Maryska Janssen-Heijnen
- Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Epidemiology, Maastricht University Medical Centre+, GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Virginia Claire Signal
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Jason K Gurney
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Eva Ja Morris
- Nuffield Department of Population Health, University of Oxford, Big Data Institute, Oxford, UK
| | - Ruth Cunningham
- Department of Public Health, School of Medicine, University of Otago, Wellington, New Zealand
| | - Diana Sarfati
- New Zealand Cancer Control Agency, Wellington, New Zealand
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3
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Seigneurin A, Delafosse P, Trétarre B, Woronoff AS, Velten M, Grosclaude P, Guizard AV, Lapôtre-Ledoux B, Bara S, Molinié F, Colonna M. Are comorbidities associated with long-term survival of lung cancer? A population-based cohort study from French cancer registries. BMC Cancer 2018; 18:1091. [PMID: 30419850 PMCID: PMC6233579 DOI: 10.1186/s12885-018-5000-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 10/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Survival rates of lung cancer remains poor and the impact of comorbidities on the prognosis is discussed. The objective of this study was to assess if the Charlson Comorbidity Index (CCI) was associated with 8-year survival rates by histological type. Methods A cohort study was conducted using randomly selected cases from 10 French cancer registries. Net survival rates were computed using the Pohar-Perme estimator of the net cumulative rate. Three Cox models were independently built for adenocarcinomas, squamous cell and small cell cancers to estimate prognostic factors including CCI grade. Results A total of 646 adenocarcinomas, 524 squamous cell and 233 small cell cancers were included in the analysis. The net 8-year survival rate ranged from 12.6% (95% CI: 9.8–15.4%) for adenocarcinomas and 13.4% (95% CI: 10.1–16.7%) for squamous cell carcinomas, to 3.7% (95% CI: 1.1–6.3%) for small cell cancers. Observed and net survival rates decreased for CCI grades ≥3 for all histological group considered. After adjustment for sex, age group, stage and diagnostic mode, CCI grades 1 (HR = 1.6 [95% CI: 1.1–2.3]), 2 (HR = 1.7 [95% CI: 1.1–2.7]) and ≥ 3 (HR = 2.7 [95% CI: 1.7–4.4]) were associated with lower survival rates only for small cell cancers. Conclusion After adjustment for age, sex, stage and diagnostic mode, the presence of comorbidity based on CCI grades 1–2 and ≥ 3 was associated with lower survival rates for small cell cancers whereas no differences were observed for adenocarcinomas and squamous cell cancers.
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Affiliation(s)
- A Seigneurin
- Isère Cancer Registry, CHU Grenoble, Grenoble, France. .,Grenoble Alpes University, Techniques de l'Ingénierie Médicale et de la Complexité - Informatique Mathématiques et Applications Grenoble, Unité Mixte de Recherche 5525, Grenoble, France. .,Medical evaluation unit, CHU Grenoble Alpes, Grenoble, France.
| | - P Delafosse
- Isère Cancer Registry, CHU Grenoble, Grenoble, France
| | - B Trétarre
- Hérault Cancer Registry, Montpellier, France
| | - A S Woronoff
- Doubs Cancer Registry, CHU Besançon, Besançon, France
| | - M Velten
- Bas-Rhin Cancer Registry, Université de Strasbourg, Strasbourg, France
| | - P Grosclaude
- Tarn Cancer Registry, Institut Claudius Regaud, IUCT-O, Registre des cancer du Tarn, Toulouse, France.,, LEASP - UMR 1027 Inserm-Université Toulouse III, Toulouse, France
| | - A V Guizard
- Calvados Cancer Registry, CLCC François Baclesse, Caen, France
| | | | - S Bara
- Manche Cancer Registry, CH du Cotentin, Cherbourg en Cotentin, France
| | - F Molinié
- Loire-Atlantique and Vendée Cancer Registry, CHU Nantes, Nantes, France
| | - M Colonna
- Isère Cancer Registry, CHU Grenoble, Grenoble, France
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Trends in lung cancer and smoking behavior in Italy: an alarm bell for women. TUMORI JOURNAL 2017; 103:543-550. [PMID: 28967091 PMCID: PMC6379803 DOI: 10.5301/tj.5000684] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2017] [Indexed: 02/02/2023]
Abstract
Introduction The epidemiology of lung cancer is changing worldwide, with smoking being the
key driver of lung cancer incidence and mortality. Our aim is to analyze the
incidence, survival and mortality trends in Italy in the framework of the
2017 survey on smoking behavior in Italy. Methods AIRTUM 2017 reports on cancer survival and incidence; 2017 survey on smoking
behavior in Italy. Results Men achieved progress in lung cancer control characterized by a decrease in
incidence and mortality and an increase in survival. The decreasing use of
tobacco in men (from 60% in the 1960s to 24% in 2017) was most likely
responsible for the decreasing incidence and mortality. Women showed no
progress: although survival improved slightly, the incidence and mortality
were both on the rise. This was most likely due to the increasing smoking
rates in women in the 1970s and 80s. Of major concern is the accelerated
rise in the number of smoking women from 4.6 million in 2016 to 5.7 million
in 2017 compared to the decrease observed in men (from 6.9 to 6
million). Conclusions The incidence and mortality trends in males clearly demonstrate that primary
prevention is the most effective way to reduce lung cancer mortality. By
contrast, a 24% increase in the prevalence of smoking among women in just 1
year is extremely worrying for the future, and calls for immediate action by
targeted strategies to reduce tobacco consumption in women and avert the
dreadful prospect of a lung cancer epidemic in Italy.
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Paci E, Puliti D, Lopes Pegna A, Carrozzi L, Picozzi G, Falaschi F, Pistelli F, Aquilini F, Ocello C, Zappa M, Carozzi FM, Mascalchi M. Mortality, survival and incidence rates in the ITALUNG randomised lung cancer screening trial. Thorax 2017; 72:825-831. [DOI: 10.1136/thoraxjnl-2016-209825] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/06/2017] [Accepted: 03/09/2017] [Indexed: 11/04/2022]
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Imperatori A, Harrison RN, Dominioni L, Leitch N, Nardecchia E, Jeebun V, Brown J, Altieri E, Castiglioni M, Cattoni M, Rotolo N. Resection rate of lung cancer in Teesside (UK) and Varese (Italy): a comparison after implementation of the National Cancer Plan. Thorax 2015; 71:230-7. [PMID: 26612687 DOI: 10.1136/thoraxjnl-2015-207572] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/24/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND In a lung cancer survey in 2000 we showed significantly less favourable stage distribution and lower resection rate in Teesside (UK) than in the comparable industrialised area of Varese (Italy). Lung cancer services in Teesside were subsequently reorganised according to National Cancer Plan recommendations. METHODS For all new lung cancer cases diagnosed in Teesside (n=324) and Varese (n=260) during the 12 months October 2010 to September 2011 (hereafter 'the 2010 cohort'), demographic, clinico-pathological and disease management data were prospectively recorded using the same database and protocol as the 2000 survey. Findings were analysed focusing on resection rate. RESULTS In the 2010 cohort compared with 2000, both in Teesside and Varese emergency referral decreased (p<0.001), performance status improved (p<0.001), but cancer stage shift was not seen; resection rate improved in Teesside, from 7% to 11% (p=0.054), and was unchanged in Varese (24%). Moreover, in Teesside compared with Varese the stage distribution remained less favourable, stage I-II non-small cell lung cancer (NSCLC) proportion being respectively 12% and 19% (p=0.040), and resection rate in all lung cancers remained lower (11% and 24%; p<0.001). On multivariate analysis, resection predictors in Teesside were as follows: stage I-II NSCLC (OR 86.14; 95% CI 31.80 to 233.37), performance status 0-1 (OR 5.02; 95% CI 1.48 to 17.07), belonging to 2010 cohort (OR 2.85; 95% CI 1.06 to 7.64). CONCLUSIONS In Teesside the main independent predictor of resection was disease stage; in 2010-2011 compared with 2000, lung cancer service improved but stage shift did not occur, and resection rate increased but remained significantly lower than in Varese.
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Affiliation(s)
- Andrea Imperatori
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Richard N Harrison
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Lorenzo Dominioni
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Neil Leitch
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Elisa Nardecchia
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Vandana Jeebun
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Jacqueline Brown
- Department of Respiratory Medicine, University Hospital of North Tees, North Tees and Hartlepool NHS Trust, Stockton on Tees, UK
| | - Elena Altieri
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Massimo Castiglioni
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Maria Cattoni
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Department of Surgical and Morphological Sciences, Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Survival patterns in lung and pleural cancer in Europe 1999–2007: Results from the EUROCARE-5 study. Eur J Cancer 2015; 51:2242-2253. [DOI: 10.1016/j.ejca.2015.07.033] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/09/2015] [Accepted: 07/20/2015] [Indexed: 12/11/2022]
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Pertile P, Poli A, Dominioni L, Rotolo N, Nardecchia E, Castiglioni M, Paolucci M, Mantovani W, Imperatori A. Is chest X-ray screening for lung cancer in smokers cost-effective? Evidence from a population-based study in Italy. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2015; 13:15. [PMID: 26366122 PMCID: PMC4567810 DOI: 10.1186/s12962-015-0041-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022] Open
Abstract
Background After implementation of the PREDICA annual chest X-ray (CXR) screening program in smokers in the general practice setting of Varese-Italy a significant reduction in lung cancer-specific mortality (18 %) was observed. The objective of this study covering July 1997 through December 2006 was to estimate the cost-effectiveness of this intervention. Methods We examined detailed information on lung cancer (LC) cases that occurred among smokers invited to be screened in the PREDICA study (Invitation-to-screening Group, n = 5815 subjects) to estimate costs and quality-adjusted life-years (QALYs) from LC diagnosis until death. The control group consisted of 156 screening-eligible smokers from the same area, uninvited and unscreened, who developed LC and were treated by usual care. We calculated the incremental net monetary benefit (INMB) by comparing LC management in screening participants (n = 1244 subjects) and in the Invitation-to-screening group versus control group. Results The average number of QALYs since LC diagnosis was 1.7, 1.49 and 1.07, respectively, in screening participants, the invitation-to-screening group, and the control group. The average total cost (screening + management) per LC case was higher in screening participants (€17,516) and the Invitation-to-screening Group (€16,167) than in the control group (€15,503). Assuming a maximum willingness to pay of €30,000/QALY, we found that the intervention was cost-effective with high probability: 79 % for screening participation (screening participants vs. control group) and 95 % for invitation-to-screening (invitation-to-screening group vs. control group). Conclusions Based on the PREDICA study, annual CXR screening of high-risk smokers in a general practice setting has high probability of being cost-effective with a maximum willingness to pay of €30,000/QALY.
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Affiliation(s)
- Paolo Pertile
- Department of Economics, University of Verona, Via dell'Artigliere 19, 37129 Verona, Italy
| | - Albino Poli
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy
| | - Lorenzo Dominioni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Nicola Rotolo
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Elisa Nardecchia
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Massimo Castiglioni
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
| | - Massimo Paolucci
- Department of Radiology, Ospedale S. Antonio Abate, Gallarate, Italy
| | - William Mantovani
- Department of Public Health and Community Medicine, University of Verona, Verona, Italy ; Department of Prevention, Public Health Trust, Trento, Italy
| | - Andrea Imperatori
- Center for Thoracic Surgery, University of Insubria, Ospedale di Circolo, Varese, Italy
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Dell'Amore A, Monteverde M, Martucci N, Davoli F, Caroli G, Pipitone E, Bini A, Stella F, Dell'Amore D, Casadio C, Rocco G. Surgery for non-small cell lung cancer in younger patients: what are the differences? Heart Lung Circ 2014; 24:62-8. [PMID: 25130384 DOI: 10.1016/j.hlc.2014.07.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Revised: 06/04/2014] [Accepted: 07/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) in young adults is uncommon. The objective of this study was to evaluate the clinicopathological characteristics, outcomes and prognosis of people younger than 50 years old treated surgically for NSCLC. METHODS A retrospective study was conducted using the institutional database of four thoracic surgery units to collect patients with NSCLC younger than 50 years who had undergone surgery. These patients were compared with older patients (>75-years) operated in the same institutions and in the same period. RESULTS We identified 113 young patients and 347 older patients. Younger patients were more likely to be female, non-smokers, with fewer comorbidities. Younger patients were more likely to be symptomatic at the time of diagnosis. Risk factors for poor prognosis in younger patients were T-stage, and disease-free-interval less than 548 days. Kaplan-Meier analysis showed a lower five-year survival in older patients compared with the younger ones (66% vs 38%, p=0.001). CONCLUSIONS In conclusion NSCLC in younger patients has some distinct clinicopathological characteristics. The overall-survival of young patients is better than in older patients. Young patients receive more complete and aggressive treatment that could explain better survival. Further prospective studies with larger patient populations are required, to clarify the biological and genetic variance of NSCLC in younger patients.
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Affiliation(s)
- Andrea Dell'Amore
- Division of Thoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy.
| | - Marco Monteverde
- Division of Thoracic Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Nicola Martucci
- Division of Thoracic Surgery, Istituto Nazionale dei Tumori, IRCCS Fondazione Pascale, Naples, Italy
| | - Fabio Davoli
- Division of Thoracic Surgery, University Eastern Piedmont, Novara, Italy
| | - Guido Caroli
- Division of Thoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Emanuela Pipitone
- Department of Formative Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandro Bini
- Division of Thoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Franco Stella
- Division of Thoracic Surgery, S.Orsola Malpighi University Hospital, Bologna, Italy
| | - Davide Dell'Amore
- Division of Thoracic Surgery, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Caterina Casadio
- Division of Thoracic Surgery, University Eastern Piedmont, Novara, Italy
| | - Gaetano Rocco
- Division of Thoracic Surgery, Istituto Nazionale dei Tumori, IRCCS Fondazione Pascale, Naples, Italy
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