Survival in Women with NSCLC: The Role of Reproductive History and Hormone Use

Abstract

Introduction Although lung cancer is the leading cause of cancer death in women, few studies have investigated the hormonal influence on survival after a lung cancer diagnosis and results have been inconsistent. We evaluated the role of reproductive and hormonal factors in predicting overall survival in women with non–small-cell lung cancer (NSCLC). Methods Population-based lung cancer cases diagnosed between November 1, 2001 and October 31, 2005 were identified through the Metropolitan Detroit Surveillance, Epidemiology, and End Results Registry. Interview and follow-up data were collected for 485 women. Cox proportional hazard regression models were used to determine hazard ratios (HRs) for death after an NSCLC diagnosis associated with reproductive and hormonal variables. Results Use of hormone therapy (HT) was associated with improved survival (HR, 0.69; 95% confidence interval, 0.54–0.89), adjusting for stage, surgery, radiation, education level, pack-years of smoking, age at diagnosis, race, and a multiplicative interaction between stage and radiation. No other reproductive or hormonal factor was associated with survival after an NSCLC diagnosis. Increased duration of HT use before the lung cancer diagnosis (132 months or longer) was associated with improved survival (HR, 0.54; 95% confidence interval, 0.37–0.78), and this finding remained significant in women taking either estrogen alone or progesterone plus estrogen, never smokers, and smokers. Conclusion These findings suggest that HT use, in particular use of estrogen plus progesterone, and long-term HT use are associated with improved survival of NSCLC.

Smoking, hormonal factors and molecular markers in female lung cancer

“…The median survival time of lung cancer patients and users of ET was 20.2 months vs 15.6 months for non-users of ET (p=0.008) [25]. In the Katcoff H. et al [26] study, E+P use was associated with a significantly improved survival for women with NSCLC taking combined HRT for 11 years or longer (p<0.0001).…”

Gender disparities in lung cancer survival from an enriched Florida population-based cancer registry

“…The American Cancer Society estimates that 234,030 new cases of lung cancer occurred in the US in 2018 and 228,150 cases in 2019, leading to 154,050 deaths and 142,670 deaths, respectively [ 1 , 2 , 4 ]. An interesting disparity reported in previous literature regarding lung cancer is the better survivorship of female patients compared to males [ [5] , [6] , [7] , [8] , [9] , [10] , [11] ]. According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (NCI-SEER) program, there are 63.5 deaths per 100,000 men compared to 39.2 deaths per 100,000 women of all race/ethnicity groups for cancer of the lung and bronchus, with women diagnosed with small cell lung cancer (SCLC) experiencing a particularly prominent survival advantage [ 5 ].…”

“…According to the National Cancer Institute's Surveillance, Epidemiology, and End Results (NCI-SEER) program, there are 63.5 deaths per 100,000 men compared to 39.2 deaths per 100,000 women of all race/ethnicity groups for cancer of the lung and bronchus, with women diagnosed with small cell lung cancer (SCLC) experiencing a particularly prominent survival advantage [ 5 ]. Previous studies utilizing NCI-SEER data from 1975 to 1999 have indicated that although women have a greater incidence of lung cancer compared to men, they also experience higher stage-specific survival rates than male counterparts [ [6] , [7] , [8] ]. Univariate and multivariable analyses have demonstrated that female gender is associated with improved lung cancer survivorship, with females diagnosed with non-small cell lung cancer (NSCLC) experiencing greater survivorship compared to males in a phase III Eastern Cooperative Oncology Group (ECOG) trial [ [8] , [9] , [10] ].…”

Estrogen Plus Progestin and Lung Cancer: Follow-up of the Women's Health Initiative Randomized Trial

“…26,27 In an older report, nonspecified hormone therapy was associated with a lower risk of death from lung cancer. 28 In 2 recent reports, a lower risk of death after lung cancer was associated with estrogen plus progestin 29 as well as with estrogen alone 30 use. We could identify no reports of lung cancer mortality relating survival to the date of hormone therapy initiation, as we report here.…”