Clinical and Pathological Characteristics of Lung Carcinoma in Young Adults_West China Medical Journal

Authors：

 JingYuting , DaiShuiping ,  LiWeimin

Department of Respiratory, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LiWeimin, Email: weimin003@163.com

Keywords：

Lung carcinoma; Young adults; Clinical and pathological characteristics

DOI：

10.7507/1002-0179.201600540

Video：

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Objective To explore the clinical and pathological characteristics of lung carcinoma in young adults, and improve the early diagnosis and treatment. Methods We retrospectively analyzed 129 patients with lung carcinoma aged from 18 to 35 years old who came to West China Hospital of Siduan University from January 1st 2008 to December 31st 2014.Also we collected 32 young adults with lung benign mass to make the comparison of the clinical and pathological characteristics with the patients. Results In the 129 patients with lung carcinoma, there were 72 females and 57 males.Adenocarcinoma (88/129) was the most common type of pathology, while others included small cell carcinoma (18/129), squamous cell carcinoma (13/129), and other types of carcinoma (10/129).Among patients with lung carcinoma, 41(31.8%) complained of refractory dry cough and another 40(31.0%) presented coughing and expectoration.Twenty-nine patients (22.5%) were misdiagnosed in their first visits.In young adults with lung carcinoma, 55.8% were at the Ⅳ stage with metastasis at the first-time diagnosis.Comparing with patients with benign lung mass, patients with lung carcinoma presented significantly more dry cough (P=0.011), chest distress (P=0.007) and weight loss (P=0.007);while fever was found more patients with lung benign mass (P=0.040).The differences in cough, expectoration, and emptysis between the two groups were not significant (P > 0.05). Conclusions Lung carcinoma in young adults often has atypical clinical presentations.Therefore, it is more commonly misdiagnosed.

Citation： JingYuting, DaiShuiping, LiWeimin. Clinical and Pathological Characteristics of Lung Carcinoma in Young Adults. West China Medical Journal, 2016, 31(12): 1961-1966. doi: 10.7507/1002-0179.201600540 Copy

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2.	支修益, 吴一龙, 马胜林, 等.原发性肺癌诊疗规范(2011年版)[J].中国肺癌杂志, 2012, 15(12):677-688.
3.	洪庆, 周瑛, 张有志, 等.我国青年肺癌误诊综述[J].临床肺科杂志, 2011, 16(3):426-427.
4.	孙顺兴, 崔超, 代震波.青年人肺癌临床特点及手术疗效分析[J].临床肺科杂志, 2008, 13(5):586-588.
5.	Whooley BP, Urschel JD, Antkowiak JG, et al. Bronchogenic carcinoma in patients age 30 and younger[J]. Ann Thorac Cardiovasc Surg, 2000, 6(2):86-88.
6.	Patel JD, Bach PB, Kris MG. Lung cancer in US women[J]. JAMA, 2004, 291(14):1763-1768.
7.	罗洪英, 王海成, 曾庆富. 30岁以下青年人肺癌的临床病理特征[J].中国肺癌杂志, 2002, 5(6):469-470.
8.	朱江, 周娟. 40岁以下青年支气管肺癌的临床病理特征分析[J].实用心脑肺血管病杂志, 2015, 23(5):90-91.
9.	王新允, 杨菊红, 马莹, 等. 107例青年肺癌的临床病理特征分析[J].中华肿瘤杂志, 2004, 26(4):243.
10.	陈茜圆, 郑扬阳, 黄晓军. 116例青年人肺癌临床及病理特征分析[J].浙江医学, 2013, 35(17):1590-1592, 1598.
11.	Rich AL, Khakwani A, Free CM, et al. Non-small cell lung cancer in young adults:presentation and survival in the English National Lung Cancer Audit[J]. QJM, 2015, 108(11):891-897.
12.	Kneuertz PJ, Chang GJ, Hu CY, et al. Overtreatment of young adults with colon cancer:more intense treatments with unmatched survival gains[J]. JAMA Surg, 2015, 150(5):402-409.
13.	Kreuzer M, Kreienbrock L, Gerken M, et al. Risk factors for lung cancer in young adults[J]. Am J Epidemiol, 1998, 147(11):1028-1037.
14.	Polednak AP. Tobacco control indicators and lung cancer rates in young adults by state in the united states[J]. Tob Control, 2008, 17(1):66-69.
15.	温建成, 王延红, 刘俊斌, 等.青年人肺癌的临床及病理特征分析[J].实用心脑肺血管病杂志, 2009, 17(6):491-492.
16.	卢家泽.青年人原发性支气管肺癌的临床及病理学特征分析[J].新医学, 2007, 38(7):450-451.
17.	侯广杰, 张连斌, 初向阳, 等.小于30岁低龄肺癌患者的临床分析[J].中国肺癌杂志, 2011, 14(5):456-458.
18.	Zang EA, Wynder EL. Differences in lung cancer risk between men and women:examination of the evidence[J]. J Natl Cancer Inst, 1996, 88(3/4):183-192.
19.	Kiyohara C, Ohno Y. Sex differences in lung cancer susceptibility:a review[J]. Gend Med, 2010, 7(5):381-401.
20.	Risch HA, Howe GR, Jain M, et al. Are female smokers at higher risk for lung cancer than male smokers? A case-control analysis by histologic type[J]. Am J Epidemiol, 1993, 138(5):281-293.
21.	Kim C, Gao YT, Xiang YB, et al. Home kitchen ventilation, cooking fuels, and lung cancer risk in a prospective cohort of never smoking women in Shanghai, China[J]. Int J Cancer, 2015, 136(3):632-638.
22.	Metayer C, Wang Z, Kleinerman RA, et al. Cooking oil fumes and risk of lung cancer in women in rural Gansu, China[J]. Lung Cancer, 2002, 35(2):111-117.
23.	Gao YT, Blot WJ, Zheng W, et al. Cancer among Chinese women[J]. Int J Cancer, 1987, 40(5):604-609.
24.	Ko YC, Lee CH, Chen MJ, et al. Risk factors for primary lung cancer among non-smoking women in Taiwan[J]. Int J Epidemiol, 1997, 26(1):24-31.
25.	Wuwilliams AH, Dai XD, Blot W, et al. Lung-cancer among women in north-east China[J]. Br J Cancer, 1990, 62(6):982-987.
26.	Mumford JL, He XZ, Chapman RS, et al. Lung-cancer and indoor air-pollution in Xuanwei, China[J]. Science, 1987, 235(4785):217-220.
27.	Lissowska J, Bardin-Mikolajczak A, Fletcher T, et al. Lung cancer and indoor pollution from heating and cooking with solid fuels:the IARC international multicentre case-control study in eastern/central europe and the united kingdom[J]. Am J Epidemiol, 2005, 162(4):326-333.
28.	Liu ZY, He XZ, Chapman RS. Smoking and pther risk factors for lung-cancer in Xuanwei, China[J]. Int J Epidemiol, 1991, 20(1):26-31.
29.	Ramanakumar AV, Parent ME, Siemiatycki J. Risk of lung cancer from residential heating and cooking fuels in Montreal, Canada[J]. Am J Epidemiol, 2007, 165(6):634-642.
30.	Mu LA, Liu L, Niu RG, et al. Indoor air pollution and risk of lung cancer among Chinese female non-smokers[J]. Cancer Causes Control, 2013, 24(3):439-450.
31.	Zhang JJ, Smith KR. Household air pollution from coal and biomass fuels in China:measurements, health impacts, and interventions[J]. Environ Health Perspect, 2007, 115(6):848-855.
32.	Shields PG, Xu GX, Blot WJ, et al. Mutagens from heated Chinese and U.S. cooking oils[J]. J Natl Cancer Inst, 1995, 87(11):836-841.
33.	Chiang TA, Wu PF, Ko YC. Identification of carcinogens in cooking oil fumes[J]. Environ Res, 1999, 81(1):18-22.
34.	Qu YH, Xu GX, Zhou JZ, et al. Genotoxicity of heated cooking oil vapors[J]. Mutat Res, 1992, 298(2):105-111.
35.	Li S, Pan D, Wang G. Analysis of polycyclic aromatic hydrocarbons in cooking oil fumes[J]. Arch Environ Health, 1994, 49(2):119-122.
36.	Chiang TA, Wu PF, Wang LF, et al. Mutagenicity and polycylic aromatic hydrocarbon content of fumes from heated cooking oils produces in Taiwan[J]. Mutat Res, 1997, 381(2):157-161.
37.	Xue W, Warshawsky D. Metabolic activation of polycyclic and heterocyclic aromatic hydrocarbons and DNA damage:a review[J]. Toxicol Appl Pharmacol, 2005, 206(1):73-93.
38.	Kris MG, Johnson BE, Kwiatkowski DJ, et al. Identification of driver mutations in tumor specimens from 1000 patients with lung aden carcinoma:the NCI's lung cancer mutation consortium (LCMC)[J]. J Clin Oncol, 2011, 29(abstract CRA7506):18.
39.	Mitsudomi T. Driver gene mutation and targeted therapy of lung cancer[J]. Gan To Kaqaku Ryoho, 2013, 40(3):285-290.
40.	Wei L, Griego AM, Chu M, et al. Tobacco exposure results in increased E6 and E7 oncogene expression, DNA damage and mutation rates in cells maintaining episomal human papillomavirus 16 genomes[J]. Carcinogenesis, 2014, 35(10):2373-2381.
41.	Primiani A, Dias-Santagata D, Iafrate AJ, et al. Pulmonary adenocarcinoma mutation profile in smokers with smoking-related interstitial fibrosis[J]. Int J Chron Obstruct Pulmon Dis, 2014, 9(1):525-531.
42.	Thu KL, Vucic EA, Chari R, et al. Lung adenocarcinoma of never smokers and smokers harbor differential regions of genetic alteration and exhibit different levels of genomic instability[J]. PLoS One, 2012, 7(3):e33003.
43.	Liu X, Lin XJ, Wang CP, et al. Association between smoking and p53 mutation in lung cancer:a meta-analysis[J]. Clin Oncol (R Coll Radiol), 2014, 26(1):18-24.
44.	Li C, Fang R, Sun Y, et al. Spectrum of monogenic driver mutation in lung Aden carcinomas from East Asian never smokers[J]. PLoS One, 2011, 6(11):e28204.
45.	Tokuhata GK, Lilienfeld AM. Family aggregation of lung cancer in humans[J]. J Natl Cancer Inst, 1963, 30(1):289-312.
46.	Tokuhata GK. Smoking habits in lung-cancer proband families and comparable control families[J]. J Natl Cancer Inst, 1963, 31(1):1153-1171.
47.	Mcduffie HH. Clustering of cancer in families of patients with primary lung cancer[J]. J Clin Epidemiol, 1991, 44(1):69-76.
48.	Ooi WL, Elston RC, Chen VW, et al. Increased familial risk for lung cancer[J]. J Natl Cancer Inst, 1986, 76(2):217-222.
49.	Samet JM, Humble CG, Pathak DR. Personal and family history of respiratory disease and lung cancer risk[J]. Am Rev Respir Dis, 1986, 134(3):466-470.

1. Rami-Porta R, Bolejack V, Giroux DJ, et al. The IASLC lung cancer staging project:the new database to inform the eighth edition of the TNM classification of lung cancer[J]. J Thorac Oncol, 2014, 9(11):1618-1624.
2. 支修益, 吴一龙, 马胜林, 等.原发性肺癌诊疗规范(2011年版)[J].中国肺癌杂志, 2012, 15(12):677-688.
3. 洪庆, 周瑛, 张有志, 等.我国青年肺癌误诊综述[J].临床肺科杂志, 2011, 16(3):426-427.
4. 孙顺兴, 崔超, 代震波.青年人肺癌临床特点及手术疗效分析[J].临床肺科杂志, 2008, 13(5):586-588.
5. Whooley BP, Urschel JD, Antkowiak JG, et al. Bronchogenic carcinoma in patients age 30 and younger[J]. Ann Thorac Cardiovasc Surg, 2000, 6(2):86-88.
6. Patel JD, Bach PB, Kris MG. Lung cancer in US women[J]. JAMA, 2004, 291(14):1763-1768.
7. 罗洪英, 王海成, 曾庆富. 30岁以下青年人肺癌的临床病理特征[J].中国肺癌杂志, 2002, 5(6):469-470.
8. 朱江, 周娟. 40岁以下青年支气管肺癌的临床病理特征分析[J].实用心脑肺血管病杂志, 2015, 23(5):90-91.
9. 王新允, 杨菊红, 马莹, 等. 107例青年肺癌的临床病理特征分析[J].中华肿瘤杂志, 2004, 26(4):243.
10. 陈茜圆, 郑扬阳, 黄晓军. 116例青年人肺癌临床及病理特征分析[J].浙江医学, 2013, 35(17):1590-1592, 1598.
11. Rich AL, Khakwani A, Free CM, et al. Non-small cell lung cancer in young adults:presentation and survival in the English National Lung Cancer Audit[J]. QJM, 2015, 108(11):891-897.
12. Kneuertz PJ, Chang GJ, Hu CY, et al. Overtreatment of young adults with colon cancer:more intense treatments with unmatched survival gains[J]. JAMA Surg, 2015, 150(5):402-409.
13. Kreuzer M, Kreienbrock L, Gerken M, et al. Risk factors for lung cancer in young adults[J]. Am J Epidemiol, 1998, 147(11):1028-1037.
14. Polednak AP. Tobacco control indicators and lung cancer rates in young adults by state in the united states[J]. Tob Control, 2008, 17(1):66-69.
15. 温建成, 王延红, 刘俊斌, 等.青年人肺癌的临床及病理特征分析[J].实用心脑肺血管病杂志, 2009, 17(6):491-492.
16. 卢家泽.青年人原发性支气管肺癌的临床及病理学特征分析[J].新医学, 2007, 38(7):450-451.
17. 侯广杰, 张连斌, 初向阳, 等.小于30岁低龄肺癌患者的临床分析[J].中国肺癌杂志, 2011, 14(5):456-458.
18. Zang EA, Wynder EL. Differences in lung cancer risk between men and women:examination of the evidence[J]. J Natl Cancer Inst, 1996, 88(3/4):183-192.
19. Kiyohara C, Ohno Y. Sex differences in lung cancer susceptibility:a review[J]. Gend Med, 2010, 7(5):381-401.
20. Risch HA, Howe GR, Jain M, et al. Are female smokers at higher risk for lung cancer than male smokers? A case-control analysis by histologic type[J]. Am J Epidemiol, 1993, 138(5):281-293.
21. Kim C, Gao YT, Xiang YB, et al. Home kitchen ventilation, cooking fuels, and lung cancer risk in a prospective cohort of never smoking women in Shanghai, China[J]. Int J Cancer, 2015, 136(3):632-638.
22. Metayer C, Wang Z, Kleinerman RA, et al. Cooking oil fumes and risk of lung cancer in women in rural Gansu, China[J]. Lung Cancer, 2002, 35(2):111-117.
23. Gao YT, Blot WJ, Zheng W, et al. Cancer among Chinese women[J]. Int J Cancer, 1987, 40(5):604-609.
24. Ko YC, Lee CH, Chen MJ, et al. Risk factors for primary lung cancer among non-smoking women in Taiwan[J]. Int J Epidemiol, 1997, 26(1):24-31.
25. Wuwilliams AH, Dai XD, Blot W, et al. Lung-cancer among women in north-east China[J]. Br J Cancer, 1990, 62(6):982-987.
26. Mumford JL, He XZ, Chapman RS, et al. Lung-cancer and indoor air-pollution in Xuanwei, China[J]. Science, 1987, 235(4785):217-220.
27. Lissowska J, Bardin-Mikolajczak A, Fletcher T, et al. Lung cancer and indoor pollution from heating and cooking with solid fuels:the IARC international multicentre case-control study in eastern/central europe and the united kingdom[J]. Am J Epidemiol, 2005, 162(4):326-333.
28. Liu ZY, He XZ, Chapman RS. Smoking and pther risk factors for lung-cancer in Xuanwei, China[J]. Int J Epidemiol, 1991, 20(1):26-31.
29. Ramanakumar AV, Parent ME, Siemiatycki J. Risk of lung cancer from residential heating and cooking fuels in Montreal, Canada[J]. Am J Epidemiol, 2007, 165(6):634-642.
30. Mu LA, Liu L, Niu RG, et al. Indoor air pollution and risk of lung cancer among Chinese female non-smokers[J]. Cancer Causes Control, 2013, 24(3):439-450.
31. Zhang JJ, Smith KR. Household air pollution from coal and biomass fuels in China:measurements, health impacts, and interventions[J]. Environ Health Perspect, 2007, 115(6):848-855.
32. Shields PG, Xu GX, Blot WJ, et al. Mutagens from heated Chinese and U.S. cooking oils[J]. J Natl Cancer Inst, 1995, 87(11):836-841.
33. Chiang TA, Wu PF, Ko YC. Identification of carcinogens in cooking oil fumes[J]. Environ Res, 1999, 81(1):18-22.
34. Qu YH, Xu GX, Zhou JZ, et al. Genotoxicity of heated cooking oil vapors[J]. Mutat Res, 1992, 298(2):105-111.
35. Li S, Pan D, Wang G. Analysis of polycyclic aromatic hydrocarbons in cooking oil fumes[J]. Arch Environ Health, 1994, 49(2):119-122.
36. Chiang TA, Wu PF, Wang LF, et al. Mutagenicity and polycylic aromatic hydrocarbon content of fumes from heated cooking oils produces in Taiwan[J]. Mutat Res, 1997, 381(2):157-161.
37. Xue W, Warshawsky D. Metabolic activation of polycyclic and heterocyclic aromatic hydrocarbons and DNA damage:a review[J]. Toxicol Appl Pharmacol, 2005, 206(1):73-93.
38. Kris MG, Johnson BE, Kwiatkowski DJ, et al. Identification of driver mutations in tumor specimens from 1000 patients with lung aden carcinoma:the NCI's lung cancer mutation consortium (LCMC)[J]. J Clin Oncol, 2011, 29(abstract CRA7506):18.
39. Mitsudomi T. Driver gene mutation and targeted therapy of lung cancer[J]. Gan To Kaqaku Ryoho, 2013, 40(3):285-290.
40. Wei L, Griego AM, Chu M, et al. Tobacco exposure results in increased E6 and E7 oncogene expression, DNA damage and mutation rates in cells maintaining episomal human papillomavirus 16 genomes[J]. Carcinogenesis, 2014, 35(10):2373-2381.
41. Primiani A, Dias-Santagata D, Iafrate AJ, et al. Pulmonary adenocarcinoma mutation profile in smokers with smoking-related interstitial fibrosis[J]. Int J Chron Obstruct Pulmon Dis, 2014, 9(1):525-531.
42. Thu KL, Vucic EA, Chari R, et al. Lung adenocarcinoma of never smokers and smokers harbor differential regions of genetic alteration and exhibit different levels of genomic instability[J]. PLoS One, 2012, 7(3):e33003.
43. Liu X, Lin XJ, Wang CP, et al. Association between smoking and p53 mutation in lung cancer:a meta-analysis[J]. Clin Oncol (R Coll Radiol), 2014, 26(1):18-24.
44. Li C, Fang R, Sun Y, et al. Spectrum of monogenic driver mutation in lung Aden carcinomas from East Asian never smokers[J]. PLoS One, 2011, 6(11):e28204.
45. Tokuhata GK, Lilienfeld AM. Family aggregation of lung cancer in humans[J]. J Natl Cancer Inst, 1963, 30(1):289-312.
46. Tokuhata GK. Smoking habits in lung-cancer proband families and comparable control families[J]. J Natl Cancer Inst, 1963, 31(1):1153-1171.
47. Mcduffie HH. Clustering of cancer in families of patients with primary lung cancer[J]. J Clin Epidemiol, 1991, 44(1):69-76.
48. Ooi WL, Elston RC, Chen VW, et al. Increased familial risk for lung cancer[J]. J Natl Cancer Inst, 1986, 76(2):217-222.
49. Samet JM, Humble CG, Pathak DR. Personal and family history of respiratory disease and lung cancer risk[J]. Am Rev Respir Dis, 1986, 134(3):466-470.

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