Subscribe to RSS
Gender Differences in Long-Term Survival after Surgery for Non-Small Cell Lung Cancer
17 May 2015
12 June 2015
14 September 2015 (online)
Background This retrospective study examined gender differences in non-small cell lung cancer (NSCLC) by analyzing surgical cases at a single institution.
Patients and Methods In this study, 735 NSCLC patients who underwent surgery from 1995 to 2010 were included. Clinical and pathological characteristics were retrieved by reviewing charts retrospectively, and variables between genders were compared.
Results There were 489 males and 246 females in the study. The percentage of screening-detected lung cancers (83.7%), never smokers (82.9%), adenocarcinoma histology (90.7%), and pathological stage IA (42.7%) was higher in females than that in males (71.2, 8.2, 51.3, and 23.1%, respectively). Female patients had fewer cases of coronary artery disease (2.8%) and fewer pneumonectomy cases (2.0%) than the male patients (7.4 and 5.3%, respectively). The median follow-up period after surgery was 5.9 years. The overall survival rates at 5 years were 57.3% for males and 76.2% for females (p < 0.001, log-rank test). Based on univariate analysis, we report that histology, smoking history, and pathological stage were significant prognostic factors in addition to gender. Based on multivariate analysis, pathological stage III/IV (hazard ratio, 3.60; 95% confidence interval [CI], 2.84–4.54) and female gender (hazard ratio, 0.55; 95% CI, 0.37–0.82) were significant prognostic factors. Subgroup analysis demonstrated that female gender and adenocarcinoma histology were significant positive prognostic factors only in pathological stages I and II (n = 557).
Conclusion Female gender as well as pathological stage was favorable prognostic factors. The survival advantage observed in female NSCLC patients was limited to those with cancer at stages I and II.
This article was presented at the 52th Annual Meeting of the Japan Lung Cancer Society, November 3–4, 2011, Osaka, Japan.
- 1 Groome PA, Bolejack V, Crowley JJ , et al; IASLC International Staging Committee; Cancer Research and Biostatistics; Observers to the Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: validation of the proposals for revision of the T, N, and M descriptors and consequent stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 694-705
- 2 Goldstraw P, Crowley J, Chansky K , et al; International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007; 2 (8) 706-714
- 3 Yoshida Y, Murayama T, Sato Y, Suzuki Y, Saito H, Tanaka N. Validation of 7th TNM staging system for lung cancer, based on surgical outcomes. Asian Cardiovasc Thorac Ann 2013; 21 (6) 693-699
- 4 Sculier JP, Chansky K, Crowley JJ, Van Meerbeeck J, Goldstraw P. The impact of additional prognostic factors on survival and their relationship with the anatomical extent of disease expressed by the 6th edition of the TNM Classification of Malignant Tumors and the proposals for the 7th Edition. J Thorac Oncol 2008; 3: 457-466
- 5 Chansky K, Sculier JP, Crowley JJ, Giroux D, Van Meerbeeck J, Goldstraw P ; International Staging Committee and Participating Institutions. The International Association for the Study of Lung Cancer Staging Project: prognostic factors and pathologic TNM stage in surgically managed non-small cell lung cancer. J Thorac Oncol 2009; 4 (7) 792-801
- 6 Sakurai H, Asamura H, Goya T , et al; Japanese Joint Committee for Lung Cancer Registration. Survival differences by gender for resected non-small cell lung cancer: a retrospective analysis of 12,509 cases in a Japanese Lung Cancer Registry study. J Thorac Oncol 2010; 5 (10) 1594-1601
- 7 de Perrot M, Licker M, Bouchardy C, Usel M, Robert J, Spiliopoulos A. Sex differences in presentation, management, and prognosis of patients with non-small cell lung carcinoma. J Thorac Cardiovasc Surg 2000; 119 (1) 21-26
- 8 Cerfolio RJ, Bryant AS, Scott E , et al. Women with pathologic stage I, II, and III non-small cell lung cancer have better survival than men. Chest 2006; 130 (6) 1796-1802
- 9 Wisnivesky JP, Halm EA. Sex differences in lung cancer survival: do tumors behave differently in elderly women?. J Clin Oncol 2007; 25 (13) 1705-1712
- 10 Chang JW, Asamura H, Kawachi R, Watanabe S. Gender difference in survival of resected non-small cell lung cancer: histology-related phenomenon?. J Thorac Cardiovasc Surg 2009; 137 (4) 807-812
- 11 Ferguson MK, Wang J, Hoffman PC , et al. Sex-associated differences in survival of patients undergoing resection for lung cancer. Ann Thorac Surg 2000; 69 (1) 245-249 , discussion 249–250
- 12 Asamura H, Goya T, Koshiishi Y , et al; Japanese Joint Committee of Lung Cancer Registry. A Japanese Lung Cancer Registry study: prognosis of 13,010 resected lung cancers. J Thorac Oncol 2008; 3 (1) 46-52
- 13 Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC , eds. Pathology & Genetics of Tumours of the Lung, Thymus and Heart (World Health Organization Classification of Tumours). Lyon: IARC Press; 2004
- 14 Sobin LH, Gospodarowicz MK, Wittekind C , eds. International Union Against Cancer (UICC). TNM Classification of Malignant Tumours. 7th ed. Oxford: Wiley-Blackwell; 2009
- 15 Travis WD, Brambilla E, Noguchi M , et al. International association for the study of lung cancer/American thoracic society/European respiratory society international multidisciplinary classification of lung adenocarcinoma. J Thorac Oncol 2011; 6 (2) 244-285
- 16 Kato H, Ichinose Y, Ohta M , et al; Japan Lung Cancer Research Group on Postsurgical Adjuvant Chemotherapy. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med 2004; 350 (17) 1713-1721
- 17 Pisters KM, Evans WK, Azzoli CG , et al; Cancer Care Ontario; American Society of Clinical Oncology. Cancer Care Ontario and American Society of Clinical Oncology adjuvant chemotherapy and adjuvant radiation therapy for stages I-IIIA resectable non small-cell lung cancer guideline. J Clin Oncol 2007; 25 (34) 5506-5518
- 18 Patel JD. Lung cancer in women. J Clin Oncol 2005; 23 (14) 3212-3218
- 19 Boffa DJ, Allen MS, Grab JD, Gaissert HA, Harpole DH, Wright CD. Data from The Society of Thoracic Surgeons General Thoracic Surgery database: the surgical management of primary lung tumors. J Thorac Cardiovasc Surg 2008; 135 (2) 247-254
- 20 Bernard A, Rivera C, Pages PB, Falcoz PE, Vicaut E, Dahan M. Risk model of in-hospital mortality after pulmonary resection for cancer: a national database of the French Society of Thoracic and Cardiovascular Surgery (Epithor). J Thorac Cardiovasc Surg 2011; 141 (2) 449-458
- 21 Masuda M, Kuwano H, Okumura M , et al; Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery. Thoracic and cardiovascular surgery in Japan during 2012: annual report by The Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg 2014; 62 (12) 734-764
- 22 Tong BC, Kosinski AS, Burfeind Jr WR , et al. Sex differences in early outcomes after lung cancer resection: analysis of the Society of Thoracic Surgeons General Thoracic Database. J Thorac Cardiovasc Surg 2014; 148 (1) 13-18
- 23 Jänne PA, Engelman JA, Johnson BE. Epidermal growth factor receptor mutations in non-small-cell lung cancer: implications for treatment and tumor biology. J Clin Oncol 2005; 23 (14) 3227-3234
- 24 Maemondo M, Inoue A, Kobayashi K , et al; North-East Japan Study Group. Gefitinib or chemotherapy for non-small-cell lung cancer with mutated EGFR. N Engl J Med 2010; 362 (25) 2380-2388
- 25 Hung JJ, Yeh YC, Jeng WJ , et al. Predictive value of the international association for the study of lung cancer/American Thoracic Society/European Respiratory Society classification of lung adenocarcinoma in tumor recurrence and patient survival. J Clin Oncol 2014; 32 (22) 2357-2364
- 26 Murayama T, Yoshida Y, Tanaka N , et al. Gender differences in long-term survival after surgery for non-small cell lung cancer. Haigan 2011; 51: 511