Assessing a survival paradox in young-onset lung adenocarcinoma: Racial and ethnic disparities in SEER analysis.

e20114 Background: Survival outcomes in young adults with lung adenocarcinoma (LUAD) are poorly characterized, particularly across racial and ethnic groups. It remains unclear whether disparities observed in the general lung cancer population persist in younger patients. Improved understanding of stage distribution and survival patterns in young-onset LUAD is needed to inform risk stratification and clinical decision-making. Methods: We analyzed patients aged 15–49 years diagnosed with LUAD between 2004 and 2016 using the SEER 17 Registries. Patients were stratified by race/ethnicity (non-Hispanic White NHW, non-Hispanic Black NHB, Hispanic, and non-Hispanic Asian or Pacific Islander NHAPI), sex, age group, and stage at diagnosis (localized, regional, distant). Five-year cause-specific survival was estimated using Kaplan–Meier methods and compared with log-rank tests. Multivariable Cox proportional hazards models evaluated associations between demographic and clinical factors and mortality. Statistical significance was defined as p < 0.05. Results: Survival differed significantly by race and ethnicity among young-onset LUAD patients (log-rank p < 0.001). Median survival was 15.0 months (95% CI,13.7–16.3) for NHB patients, 18.0 months (95% CI,16.9–19.1) for NHW patients, 23.0 months (95% CI,20.8–25.2) for Hispanic patients, and 27.0 months (95% CI,24.4–29.6) for NHAPI patients. Across all racial and ethnic groups, advanced stage at diagnosis was the strongest predictor of mortality, with distant-stage disease associated with markedly increased hazards of death compared with localized disease (NHB HR2.98; NHW HR3.49; Hispanic HR3.33; NHAPI HR3.80; all p < 0.001). Male sex was independently associated with higher mortality across all groups. Among NHW patients, younger age (15–39 vs 40–49 years) was associated with lower mortality (HR0.81;95%CI,0.74–0.89). Despite adjustment for these factors, NHAPI patients consistently demonstrated superior survival. Conclusions: NHAPI patients with young-onset LUAD experience significantly improved survival compared with other racial and ethnic groups, while NHB and NHW patients have poorer outcomes. These findings reveal persistent survival disparities in young-onset LUAD and highlight the need for tailored early detection strategies and biologic and treatment-focused research to address these differences.