Gender-Related Survival in Different Stages of Lung Cancer—A Population Study over 20 Years

Abstract

Introduction: Tumour stage is the most important prognostic factor in non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC). The aim of this study was to evaluate if female gender was a prognostic factor in different tumour stages in relation to histology and given therapy. Methods: From 1989-2008, 1497 patients in eastern Scania, in southern Sweden with 202,000 inhabitants, were referred and prospectively registered. Tumour stage, performance status, lung cancer type and primary therapy were registered. Results: In NSCLC, female patients in stages 1 and 2 who were treated with surgery had a better 5-year survival rate (79.4%), compared to males (60.6%; p = 0.0004). Female patients in stage 3 with active therapy (surgery and/or radiotherapy and/or chemotherapy) had a better 5-year survival than males (20.6% vs. 10.5%, respectively, p = 0.0006). Female patients with adenocarcinoma were favourable in stages 1-3. In stage 4, there was no survival difference between females and males. In SCLC, females with limited disease (LD) and active therapy (chemotherapy ± radiotherapy ± surgery) had a higher 5-year survival rate (28%) than males (5.6%); p = 0.001. Females with extensive disease (ED) and active therapy (chemotherapy ± radiotherapy) had a better 5-year survival (3.9%) compared to males (0.7%); p = 0.023. In multivariate analyses, patient performance status at diagnosis was also an independent prognostic factor in all tumour stages of lung cancer. Conclusions: This population-based study corroborates a female survival advantage in NSCLC stages 1-3, but not in metastatic stage 4, and this is also demonstrated for the adenocarcinoma subgroup. The study also confirms better prognosis in females with SCLC in both LD and ED. The study also demonstrates the importance of patient performance status as a prognostic factor in all stages of lung cancer.

Risk Factors for Brain Metastases in Patients With Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

“…We also showed a marginally significant risk of developing BM in males. This is consistent with former reports illustrating that female patients had better prognosis than males, in SCLC (62), NSCLC (83), or other cancer sites (84). Reasons for this are not clear, but could include lower proliferation indexes (85), lower levels of p-glycoprotein (86,87), more frequently expressed thyroid transcription factor-1 (TTF-1) (88), and sex hormone patterns (84).…”

Trend analysis of major cancer statistics according to sex and severity levels in Korea

“…The 5-year observed survival rate of lung cancer in the localized stage was 31.9% in men and 48.1% in women, respectively. Differences in the histological type of lung cancer are considered as a plausible explanation for these differences [ 25 ], but there has also been speculation that men with lung cancer might be more likely to be current or former smokers than women with lung cancer, which could contribute to the presence of more comorbid conditions in male patients than in female patients [ 26 ]. In Korea, the current smoking rate in men (42.1%) was seven times higher than that in women (6.2%) in 2013 [ 27 ].…”