非小细胞肺癌生存的性别差异：对1997年至2002年间确诊的4618例患者的分析

Gender differences in non-small-cell lung cancer survival: an analysis of 4,618 patients diagnosed between 1997 and 2002.

作者信息

Visbal Antonio L, Williams Brent A, Nichols Francis C, Marks Randolph S, Jett James R, Aubry Marie-Christine, Edell Eric S, Wampfler Jason A, Molina Julian R, Yang Ping

机构信息

Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA.

出版信息

Ann Thorac Surg. 2004 Jul;78(1):209-15; discussion 215. doi: 10.1016/j.athoracsur.2003.11.021.

DOI:10.1016/j.athoracsur.2003.11.021

PMID:15223430

Abstract

BACKGROUND

Gender has been reported as a predictor for nonsmall cell lung cancer (NSCLC) survival. Most of the reports are limited to selected groups of patients. The magnitude of gender effect on NSCLC survival across disease stage, tumor histology, and therapies needs to be further characterized.

METHODS

A cohort of 4,618 patients diagnosed with NSCLC was prospectively enrolled and actively followed. Vital status of each patient was verified through multiple complementary sources. Cox proportional hazards models were developed to compare postdiagnosis survival between genders adjusting for age at diagnosis, tumor histology and grade, stage, pack-years smoked, and treatment received (resection, radiation, or chemotherapy).

RESULTS

There were 2,724 men (59%) and 1,894 women (41%), with a median age at diagnosis of 68 years in men and 66 in women (p < 0.01). More men smoked and were heavier smokers than women. Adenocarcinoma was the most frequent histology in both genders. No difference was found in stage and treatment between genders. The estimated survival in men was 51% (95% CI: 49%, 53%) and 15% (95% CI: 12%, 17%) at one and five years, respectively, and in women was 60% (95% CI: 58%, 62%) and 19% (95% CI: 16%, 22%). Men were at a significantly increased risk of mortality compared to women following a diagnosis of NSCLC (adjusted relative risk: 1.20, 95% CI: 1.11, 1.30), particularly for patients with stage III/IV disease or adenocarcinoma.

CONCLUSIONS

Male gender is confirmed to be an independent unfavorable prognostic indicator for NSCLC survival.

摘要

背景

性别已被报道为非小细胞肺癌（NSCLC）生存的一个预测因素。大多数报告仅限于特定的患者群体。性别对NSCLC在不同疾病阶段、肿瘤组织学类型和治疗方式下生存的影响程度需要进一步明确。

方法

前瞻性纳入并积极随访了4618例被诊断为NSCLC的患者队列。通过多种补充来源核实每位患者的生存状态。建立Cox比例风险模型，比较性别之间的诊断后生存情况，并对诊断时的年龄、肿瘤组织学类型和分级、分期、吸烟包年数以及接受的治疗（手术切除、放疗或化疗）进行校正。

结果

有2724名男性（59%）和1894名女性（41%），男性诊断时的中位年龄为68岁，女性为66岁（p<0.01）。吸烟的男性比女性更多且吸烟量更大。腺癌是两性中最常见的组织学类型。两性在分期和治疗方面未发现差异。男性1年和5年的估计生存率分别为51%（95%CI：49%，53%）和15%（95%CI：12%，17%），女性分别为60%（95%CI：58%，62%）和19%（95%CI：16%，22%）。与女性相比，男性在诊断为NSCLC后死亡风险显著增加（校正相对风险：1.20，95%CI：1.11，1.30），尤其是对于III/IV期疾病或腺癌患者。