In NSCLC, Do Women Have Better Survival Than Men?

BIRMINGHAM, ALA—Lung cancer kills more women than breast, colorectal, and ovarian cancer combined. Despite this grim fact, new research reveals that women with stage I, II, or III non–small cell lung cancer (NSCLC) have better survival rates than men.¹

Robert J. Cerfolio, MD, and colleagues performed a seven-year prospective study and evaluated 1,085 patients 19 and older (671 men and 414 women) with NSCLC stages I through III; most had a history of smoking. At baseline, women had slightly better lung function than men (FEV1, 83% vs 78%, respectively). Treatment varied according to presence of cancer and stage. Stage II patients received platinum-based chemotherapy and resection, and those with stage IIIa received neoadjuvant platinum-based chemoradiotherapy. Said Dr. Cerfolio, Chief of the Section of Thoracic Surgery at the University of Alabama at Birmingham, “Even when patients are carefully staged prior to surgery and intraoperatively staged using complete thoracic lymphadenectomy and lung palpation, women do better than men, stage for stage.”

Women's Characteristics

In general, women were younger than men (average age, 62 vs 69); however, this age difference and women’s better results on pulmonary function tests were controlled for in the analysis. The improvement in survival of women over men may be because of genetic differences between sexes, viral infections that are specific to women (such as human papillomavirus), or growth factors, the researchers noted. Women also presented with disease in earlier stages and had a higher incidence of adenocarcinoma than men.

Most importantly, overall the survival rate  was significantly higher in women (60%) than in men (50%). The survival advantage appears to occur within the first few months after diagnosis. The five-year survival rate was also higher for women regardless of disease stage: Women with stage I disease experienced a 69% five-year survival rate, versus 64% for men. In stage II disease, 60% of the women in the study were alive after five years, versus half of the men. The five-year survival rate for stage III disease was 46% in women versus 37% in men.

Women also had a better response than men did to neoadjuvant chemotherapy alone: 20% of women and only 10% of men experienced a complete response to neoadjuvant chemotherapy. A partial response to treatment was experienced by 59% of women versus 41% of men. Survival rates among patients with stage IIIa disease did not differ between the sexes.

Dr. Cerfolio acknowledged that women’s better survival and response to treatment is probably due to a number of factors, but that future research needs to uncover what these factors are.

—Tamara Gibb

Reference
1. 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;130:1796-1802.

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