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Women with Pathologic Stage I, II and III Non-Small Cell Lung Cancer have Better Survival than Men

A. S. Bryant, R. J. Cerfolio. University of Alabama at Birmingham, Birmingham, AL,

BACKGROUND: Bronchogenic malignancy is the number one cause of cancer deaths in men and women worldwide. National registry studies have shown gender disparity in clinicopathologic characteristics and in survival. This study evaluates risk factors and trends of lung cancer between genders.
METHODS: A prospective cohort of consecutive patients with non-small cell lung cancer (NSCLC) who were clinically (all received dedicated positron emission tomography) then pathologically staged with I, II or III disease, underwent homogenous treatment algorithms and were followed over seven years. Primary outcomes were 5-year survival and response to neoadjuvant therapy.
RESULTS:There were 1,085 patients (671 men, 414 women). Groups were similar for race, pulmonary function, smoking history, comorbidities, neoadjuvant therapy, histology and resection rates. Women were younger (p=0.014), had a higher incidence of adenocarcinoma (p=0.01) and presented at an earlier pathologic stage (p=0.01) than men. Overall age and stage adjusted 5-year survival favored women (60% compared to 50%, p<0.001). Women had better stage-specific 5-year survival: 69% versus 64%, for stage I (p=0.034), 60% versus 50% for stage II (p=0.042) and 46% versus 37% for stage III (p=0.024). Women who received neoadjuvant chemotherapy alone (N=76) were more likely to be a complete or partial responder than men (N=142, p=0.025).
CONCLUSIONS:Despite uniform staging and treatment, the 5-year survival of women with stage I-III non-small cell lung cancer is better than men, overall and at each stage. Women are more likely to have adenocarcinoma, to present with earlier stage disease and be younger. Interestingly, women respond better to neoadjuvant chemotherapy.
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