Prognostic factors and surgical management in pediatric primary lung cancer: a retrospective cohort study using SEER data

BACKGROUND: Primary lung cancer (LC) is extremely rare in pediatric patients, making diagnosis and management particularly challenging. Currently, there are no established guidelines for treating LC in this age group, and both prognosis and treatment experiences are scarcely studied. This study aims to evaluate prognostic factors and assess the survival benefits of surgical intervention in pediatric LC patients. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 1988 to 2019, encompassing 337 children aged 0–19 years diagnosed with primary LC. Clinical characteristics, prognostic factors, and surgical approaches were elucidated. Prognostic markers for overall survival (OS) were evaluated through univariate and multivariate Cox proportional hazards regression models. Survival analysis between groups utilized Kaplan-Meier survival curves. RESULTS: The children indicated a median age of 15 years and the female-to-male ratio was close to 1:1. The most common pathological type was carcinoid tumor (31.45%). Most of the tumors were <5 cm in diameter (63.79%) or confined in situ (46.77%). The 5-year OS rate for the entire cohort was 77.9%, with pathologic classification, SEER stage, surgery, and tumor size identified as independent prognostic factors. Pulmonary/pleuropulmonary blastoma [hazards ratio (HR): 6.41; 95% confidence interval (CI): 1.69–24.35; P=0.006] or adenocarcinoma (HR: 8.82; 95% CI: 2.20–35.25; P=0.002), no surgery (HR: 2.05; 95% CI: 1.13–3.72; P=0.02), and tumor size ≥5 cm (HR: 2.87; 95% CI: 1.20–6.89; P=0.02) were associated with a worse prognosis in pediatric LC patients. In localized of SEER stage (HR: 0.15; 95% CI: 0.04–0.56; P=0.005) was associated with a better prognosis in pediatric LC patients. Common pathological types including carcinoid, pulmonary/pleuropulmonary blastoma, and mucoepidermoid carcinoma demonstrated the most favorable prognosis (P<0.001). Surgery did not significantly benefit patients with American Joint Committee on Cancer (AJCC) stage IV (HR: 0.83; 95% CI: 0.42–1.62; P=0.58) or distant-stage disease (HR: 0.59; 95% CI: 0.33–1.06; P=0.06). Conversely, children with regional lymph node metastasis (HR: 0.23; 95% CI: 0.06–0.88; P=0.02) or AJCC stage III–IV (HR: 0.40; 95% CI: 0.19–0.87; P=0.02) showed improved survival following lymph node dissection. Tumor size also influenced surgical decision-making, with smaller tumors (<5 cm) favoring surgical resection, including lobectomy (P<0.001) or local tumor resection (P=0.03), while larger tumors exhibited advantages with less specificity regarding surgical approach (P=0.15). CONCLUSIONS: This study identified pathologic classification, SEER stage, surgery, and tumor size as independent prognostic factors for pediatric LC. For children with advanced-stage LC, surgical intervention may not extend survival time. This study underscores the importance of tailoring therapeutic strategies based on histology, disease stage, and tumor size. These findings offer valuable insights into managing pediatric LC, enabling more informed clinical decisions and potentially enhancing patient outcomes.