Gender differences in non–small-cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and 2002

doi:10.1016/j.athoracsur.2003.11.021

The Annals of Thoracic Surgery

Volume 78, Issue 1, July 2004, Pages 209-215

https://doi.org/10.1016/j.athoracsur.2003.11.021 Get rights and content

Abstract

Background

Gender has been reported as a predictor for nonsmall cell lung cancer (NSCLC) survival. Most of the reports are limited to selected groups of patients. The magnitude of gender effect on NSCLC survival across disease stage, tumor histology, and therapies needs to be further characterized.

Methods

A cohort of 4,618 patients diagnosed with NSCLC was prospectively enrolled and actively followed. Vital status of each patient was verified through multiple complementary sources. Cox proportional hazards models were developed to compare postdiagnosis survival between genders adjusting for age at diagnosis, tumor histology and grade, stage, pack-years smoked, and treatment received (resection, radiation, or chemotherapy).

Results

There were 2,724 men (59%) and 1,894 women (41%), with a median age at diagnosis of 68 years in men and 66 in women (p < 0.01). More men smoked and were heavier smokers than women. Adenocarcinoma was the most frequent histology in both genders. No difference was found in stage and treatment between genders. The estimated survival in men was 51% (95% CI: 49%, 53%) and 15% (95% CI: 12%, 17%) at one and five years, respectively, and in women was 60% (95% CI: 58%, 62%) and 19% (95% CI: 16%, 22%). Men were at a significantly increased risk of mortality compared to women following a diagnosis of NSCLC (adjusted relative risk: 1.20, 95% CI: 1.11, 1.30), particularly for patients with stage III/IV disease or adenocarcinoma.

Conclusions

Male gender is confirmed to be an independent unfavorable prognostic indicator for NSCLC survival.

Section snippets

Study population

Between January 1, 1997 and December 31, 2002, a cohort of 4,618 patients with pathologically diagnosed and/or confirmed NSCLC at Mayo Clinic (Minnesota, USA) were prospectively enrolled in this study and actively followed. Ninety-five percent of all new lung cancer patients seen at the Mayo Clinic were identified daily from our computerized pathology reporting system with the remaining 5% referred directly from the patient-care physicians. Only patients giving informed consent for research

Results

Among the 4,618 patients diagnosed with NSCLC during this six-year period, there were 2,724 men (59%) and 1,894 women (41%), a 1.44:1 male to female ratio. Median age at diagnosis was 68 years in men (range, 18 to 95) and 66 in women (range, 24 to 97), p less than 0.01. White was the most frequent ethnic group (95.6% of women and 96.8% of men). Minority groups included Alaskan/Indian, African American, Hispanic, Asian/Pacific Islanders, and Other.

Adenocarcinoma was the most frequent

Comment

This study confirms that male gender is an unfavorable prognostic factor for NSCLC survival. Our results show an increased mortality compared to women patients in our cohort of prospectively and actively followed series of patients diagnosed over a six-year period when histologic classification [18], staging system 18, 19 and treatment options for NSCLC remained constant. The survival for men in stage IA is similar to women in stage IB, men in stage IIA is similar to women in stage IIB, and so

Conclusion

Characteristics of our patient population reflect the current trends of lung cancer brought by changes in smoking behavior. Female patients smoke less but seem more susceptible to develop lung cancer earlier in life than male patients. Although adenocarcinoma is the most common subtype in both genders, women have proportionally more adenocarcinomas than men do. Women have a better survival than their male counterparts after considering age, smoking history, tumor histology and grade, stage,

Acknowledgements

We thank Drs Claude Deschamps, Daniel L. Miller, David E. Midthun, Alex A. Adjei, Aminah Jatoi, and Mark S. Allen for their input at various stages of this work. We also thank Susan Ernst for her technical assistance with the manuscript. This work was supported by grants CA 80127 and CA84354 from the US National Cancer Institute and by Mayo Foundation Funds.

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Original article: general thoracicGender differences in non–small-cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and 2002

Abstract

Background

Methods

Results

Conclusions

Section snippets

Study population

Results

Comment

Conclusion

Acknowledgements

Lung Cancer

J Thorac Cardiovasc Surg

Chest

Chest

Mayo Clin Proc

Ann Thorac Surg

J Thorac Cardiovasc Surg

Lung Cancer

Lung Cancer

Lung Cancer

Ann Thorac Surg

Lung Cancer

Annual report to the nation of the status of cancer, 1973–1996; with a special section on lung cancer and tobacco smoking

J Natl Cancer Inst

Lung carcinoma trends by histologic type in Vaud and Neuchatel, Switzerland, 1974–1994

Cancer

United States lung carcinoma incidence trendsdeclining for most histologic types among males, increasing among females

Cancer

Original article: general thoracic
Gender differences in non–small-cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and 2002