Sex differences in survival in non-small cell lung cancer patients 1974–1998

Abstract

This study comprised a total of 7,553 patients with non-small cell lung cancer (2,660 women and 4,893 men) treated at a comprehensive cancer centre between 1974 and 1998. Significant differences in tumour histology were associated with gender (p < 0.001); adenocarcinoma was the most common diagnosis in both men (50.0%) and women (41.7%); squamous cell carcinoma was the second most prevalent diagnosis (21% and 31% in women and men, respectively); and bronchioalveolar tumours were more prevalent in men (3% compared with 7% in women). Frequency distributions with local, regional or distant disease at registration were similar between men and women (p = 0.906). In a multivariable Cox regression analysis the indications were that gender is an important risk factor for survival. Adjusting for age, stage, treatment received and ability to pay for care, a statistically significant interaction between gender and tumour histology (p = 0.043) was found, where, in relation to female sex and histologies other than squamous carcinoma, women who presented with squamous carcinoma had an increased risk of death (HR = 1.09, 95% CI 1.02-1.18) while men had an increased risk of death for all histologies (HR = 1.29, 95% CI 1.21-1.40, and HR = 1.15, 95% CI 1.07-1.24 for squamous and other histologies, respectively). This study confirms previous reports of strong gender-dependent differences in survival in patients with non-small cell lung cancer, including a histology-specific effect in women.

Impact of new chemotherapeutic and targeted agents on survival in stage IV non-small cell lung cancer.

“…It has been proposed that the improved survival of lung cancer patients over time might be attributed in part to the increased incidence of lung cancer in women, and the observation that women with NSCLC generally have better survival outcomes than men [16,17]. However, in our survival analysis, female gender was not a significant predictor of longer survival.…”

Is sex associated with the outcome of patients treated with radiation for nonsmall cell lung cancer?

“…[3][4][5][6][7][8]10,11 For example, in a prospective study of 1085 patients with stage I to III NSCLC, Cerfolio et al found that women had a significantly higher 5-year OS rate than men (60% vs 50%; P < .001). 3 In that study, OS rates for both sexes were higher than in ours, most likely because their patients were seen in a surgical clinic, which limited the study population to patients who were surgical candidates.…”

“…6,21,22 Therapeutic disparities may also influence the survival of men and women with NSCLC, 10,23,24 but it has been shown that the OS advantage for women persists regardless of treatment received. 7,10,12 To our knowledge to date, no study has provided a thorough analysis of whether sex influences the treatment or outcome of NSCLC patients receiving radiation. Previous studies have been limited by differences in radiation dose and technique among institutions, incomplete radiation records in population-based registries, and the confounding relationship between disease stage and the use of radiation as a treatment.…”

Interleukin-18 promoter polymorphism is associated with lung cancer: A case-control study

“…Most patients are diagnosed at a late clinical stage, and despite significant improvements in conventional therapies for lung cancer, the overall 5-year survival remains poor [2].…”