Background: Young patients with non-small cell lung cancer (NSCLC) represent a distinct biological subgroup, frequently enriched with actionable oncogenic drivers.However, real-world survival data from Latin America are limited.We evaluated survival outcomes and prognostic factors in young versus older patients with NSCLC treated in Peru. Methods:We conducted a retrospective cohort study including patients with histologically confirmed NSCLC treated between 2018 and 2024 at a national reference cancer center.Patients were stratified by age at diagnosis (<45 vs 45 years).Overall survival (OS) was estimated using the Kaplan-Meier method.Multivariable Cox regression was performed adjusting for sex, ECOG performance status, smoking history, clinical stage, histology, molecular alterations and first-line treatment.Results: A total of 317 patients were included; 19.9% were younger than 45 years.The cohort was predominantly female (59.3%), never-smokers (85.5%) and had adenocarcinoma histology (95.6%).Advanced disease (stage III-IV) was present in 94.0% of cases.Actionable molecular alterations were identified in 69.4% of patients, most commonly EGFR mutations (48.3%).Younger patients showed a higher frequency of actionable mutations compared with older patients (70% vs 56%, p=0.038).After a median follow-up of 40.9 months, 92 deaths (29.0%) were recorded.In adjusted analysis, young age was not associated with worse OS (adjusted HR 1.32; 95% CI 0.79-2.21;p=0.29).Former smoking history was the only independent predictor of inferior OS (adjusted HR 2.38; p=0.018).Conclusions: Young age at NSCLC diagnosis was not associated with inferior survival.Despite advanced-stage presentation, younger patients exhibited a high prevalence of actionable oncogenic drivers, supporting routine comprehensive molecular profiling.These results provide robust regional evidence and reinforce the importance of precision oncology in underrepresented populations.
Michiels et al. (Tue,) studied this question.