Stage-Survival Paradox in Young-Onset Lung Adenocarcinoma Patients Among Asian and Pacific Islander Women: A...

Lung adenocarcinoma (LUAD) in young adults may represent a distinct entity with sex and ancestry-related differences. Population-level data on incidence and survival remain limited. We assessed age- and stage-specific trends in early-onset LUAD and evaluated racial and sex disparities in presentation and outcomes.

We used the Surveillance, Epidemiology, and End Results (SEER) database to identify patients aged 15-49 years diagnosed with LUAD. Age-adjusted incidence and stage-specific trends were assessed using joinpoint regression. Cause-specific survival was analyzed using Kaplan-Meier methods and multivariable Cox regression, focusing on non-Hispanic Asian or Pacific Islander (NHAPI) females.

Among 14,109 patients, 1,149 (8.1%) were NHAPI females. Incidence trends were heterogeneous across groups, with relatively stable patterns in NHAPI females and variable trends in other populations. NHAPI females more frequently presented with distant-stage disease than non-Hispanic White patients (73.6% vs. 68.0%; p = 0.001). Despite this, they demonstrated superior survival. Five-year cause-specific survival was higher in NHAPI females, with a median survival of 38.0 versus 24.0 months in non-Hispanic White patients (log-rank p < 0.001). In multivariable analysis, non-Hispanic White patients had increased mortality risk compared with NHAPI females (HR 1.25, 95% CI 1.12-1.41). Stage remained the strongest prognostic factor, with higher risk in regional (HR 3.51) and distant disease (HR 12.41) versus localized disease (both p < 0.001).

Young NHAPI females represent a distinct LUAD subgroup characterized by a paradox of advanced-stage presentation but improved survival. These findings highlight clinically meaningful heterogeneity and support targeted strategies for early detection and prevention.