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Background <p>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.</p> Methods <p>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.</p> Results <p>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%; <i>p</i> = 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 <i>p</i> &lt; 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 <i>p</i> &lt; 0.001).</p> Conclusions <p>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.</p>

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

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Hnada Samaan,
  • Sohaib A. Alomari,
  • Sara Fakeh,
  • Muhammad Awidi

摘要

Background

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.

Methods

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.

Results

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).

Conclusions

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.