Moore Rhonda, Doherty Dorota, Chamberlain Robert, Khuri Fadlo
Department of Epidemiology, Laboratory of Functional and Molecular Imaging, NINDS, Bethesda, MD 20892-1065, USA.
Acta Oncol. 2004;43(1):57-64.
This study comprised a total of 7,553 patients with non-small cell lung cancer (2,660 women and 4,893 men) treated at a comprehensive cancer centre between 1974 and 1998. Significant differences in tumour histology were associated with gender (p < 0.001); adenocarcinoma was the most common diagnosis in both men (50.0%) and women (41.7%); squamous cell carcinoma was the second most prevalent diagnosis (21% and 31% in women and men, respectively); and bronchioalveolar tumours were more prevalent in men (3% compared with 7% in women). Frequency distributions with local, regional or distant disease at registration were similar between men and women (p = 0.906). In a multivariable Cox regression analysis the indications were that gender is an important risk factor for survival. Adjusting for age, stage, treatment received and ability to pay for care, a statistically significant interaction between gender and tumour histology (p = 0.043) was found, where, in relation to female sex and histologies other than squamous carcinoma, women who presented with squamous carcinoma had an increased risk of death (HR = 1.09, 95% CI 1.02-1.18) while men had an increased risk of death for all histologies (HR = 1.29, 95% CI 1.21-1.40, and HR = 1.15, 95% CI 1.07-1.24 for squamous and other histologies, respectively). This study confirms previous reports of strong gender-dependent differences in survival in patients with non-small cell lung cancer, including a histology-specific effect in women.
本研究共纳入了1974年至1998年间在一家综合癌症中心接受治疗的7553例非小细胞肺癌患者（2660例女性和4893例男性）。肿瘤组织学存在显著的性别差异（p < 0.001）；腺癌是男性（50.0%）和女性（41.7%）中最常见的诊断类型；鳞状细胞癌是第二常见的诊断类型（女性和男性中分别为21%和31%）；细支气管肺泡肿瘤在男性中更为常见（3%，而女性为7%）。登记时局部、区域或远处疾病的频率分布在男性和女性之间相似（p = 0.906）。在多变量Cox回归分析中，有迹象表明性别是生存的重要危险因素。在调整年龄、分期、接受的治疗和支付医疗费用的能力后，发现性别与肿瘤组织学之间存在统计学上显著的相互作用（p = 0.043），其中，对于女性以及除鳞状细胞癌以外的其他组织学类型，患鳞状细胞癌的女性死亡风险增加（HR = 1.09，95% CI 1.02 - 1.18），而男性在所有组织学类型中死亡风险均增加（鳞状细胞癌和其他组织学类型的HR分别为1.29，95% CI 1.21 - 1.40和HR = 1.15，95% CI 1.07 - 1.24）。本研究证实了先前关于非小细胞肺癌患者生存存在强烈性别依赖性差异的报道，包括女性中存在的组织学特异性效应。
