Women with pathologic stage I, II, and III non-small cell lung cancer have better survival than men
Women with pathologic stage I, II, and III non-small cell lung cancer have better survival than men
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DOI：
10.1378/chest.130.6.1796
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发表时间：
2006-12-01
期刊：
影响因子：
9.6
通讯作者：
Garver, Robert I.
中科院分区：
文献类型：
--
作者：
Cerfolio, Robert James;Bryant, Ayesha S.;Garver, Robert I.
目的：支气管源性恶性肿瘤是全世界男性和女性癌症死亡的头号原因。基于国家登记的研究表明，在临床病理特征和生存方面存在性别差异。本研究评估了不同性别之间肺癌的危险因素和趋势。方法：对非小细胞肺癌（NSCLC）的连续患者进行前瞻性队列研究，这些患者经过仔细的临床检查（所有患者都进行了专门的正电子发射断层扫描），病理分期为I期、II期或III期，接受了同质治疗算法，随访时间超过7年。主要结局是5年生存率和对新辅助治疗的反应。结果：共1085例患者，其中男性671例，女性414例。各组在种族、肺功能、吸烟史、合并症、新辅助治疗、组织学和切除率方面相似。与男性相比，女性更年轻（p = 0.014），腺癌发病率更高（p = 0.01），病理分期更早（p = 0.01）。总体年龄调整和分期调整5年生存率较好。女性（分别为60% vs 50%； p < 0.001）。女性有更好的分期特异性5年生存率（I期，分别为69%对64% [p = 0.034]； II期，分别为60%对50% [p = 0.042]； III期，分别为46%对37% [p = 0.024]）。单独接受新辅助化疗的女性（n = 76）比男性更有可能完全或部分缓解（n = 142; p = 0.025）。结论：尽管分期和治疗方法统一，但I - III期NSCLC女性患者的5年生存率总体上和各期均优于男性。女性更容易患腺癌，更容易出现早期疾病，而且更年轻。有趣的是，女性对新辅助化疗的反应更好。
Objective: Bronchogenic malignancy is the number one cause of cancer deaths in both men and women worldwide. National registry-based studies have shown gender disparity in clinicopathologic characteristics and in survival. This study evaluates the 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 carefully clinically (all underwent dedicated positron emission tomography scans) and pathologically staged with stage I, II, or III disease underwent homogenous treatment algorithms and were followed up over a period of 7 years. Primary outcomes were 5-year survival and response to neoadjuvant therapy.Results: There were 1,085 patients (671 men and 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. The overall age-adjusted and stage-adjusted 5-year survival rate favored. women (60% vs 50%, respectively; p < 0.001). Women had better stage-specific 5-year survival rates (stage I disease, 69% vs 64%, respectively [p = 0.034]; stage II disease, 60% vs 50%, respectively [p = 0.042]; and stage III disease, 46% vs 37%, respectively [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 rate of women with stage I to III NSCLC was better than men overall and at each stage. Women are more likely to have adenocarcinoma, to present with earlier stage disease, and to be younger. Interestingly, women respond better to neoadjuvant chemotherapy.