The female gender has a positive effect on survival independent of background life expectancy following surgical resection of primary non-small cell lung cancer: a study of absolute and relative survival over 15 years
Introduction
Carcinoma of the lung remains a major health problem with an overall 5-year absolute survival in Norway of 9% for men and 12% for women [1]. Prognosis is generally found to depend on the patient's clinical condition, gender and age, stage of disease at the time of diagnosis and histological type [2], [3], [4], [5], [6], [7], [8], [9], [10]. Complete surgical resection is the treatment of choice for non-advanced non-small cell lung cancer, but even this group of patients are encumbered with a relative poor long time prognosis [11], [12], [13]. The incidence of lung cancer has declined for men but continues to increase for women, now being the second cause of cancer-related death in the European female population and the most frequent cause of cancer-related death among women in North America [14], [15]. This is in parallel to the increase in the prevalence of cigarette smoking among females.
In general, patients that are candidates for lung resection for carcinoma are at a relatively high age. Many previous studies have focused on the late survival without taking into consideration the high co-morbidity with regard to age and other diseases. As many as 19–30% of pT1N0M0 NSCLC undergoing surgery die of causes not related to lung cancer [16], [17]. Additional cardiovascular disease, in particular, seems to influence the long time survival [18].
The purpose of this study was to examine if long time survival for patients operated for non-small cell lung cancer have changed over a 15 years period.
Section snippets
Patients
In this retrospective study all medical records, but one that was lost, of 466 patients undergoing thoracotomy between 1 January 1988 and 31 December 2002 at Haukeland University Hospital were scrutinised and 109 patients excluded due to non-cancer-related thoracotomy, benign or non-conclusive tumour histology, small cell carcinoma, secondary tumours, secondary operations and explorative operation. Five additional patients undergoing a sub-optimal and limited lung resection, based on per
Patients
The mean age of patients was 64.3 ± 10.3 years (range 25–83 years) with no significant difference between the 238 males and 113 females included in the study (Table 1). The preoperative predicted FVC and FEV1 was 94.0% (83.0; 106.0) and 83.0% (72.0; 95.0), respectively, males having significant lower predicted FVC than females (P = 0.036). At the time of diagnosis 34.0% of male patients had or had been treated for cardiovascular disease, defined as angina pectoris, coronary or cerebral thrombosis,
Discussion
This study reports results with regard to patient survival in a 15-year period for 351 patients operated with intention to cure, for non-small cell lung carcinoma in a university hospital in Norway. It has been shown that the risk of death for these patients clearly exceed risk of death from all causes for the general population matched for sex and age at the time of operation during the first 4–5 years after diagnosis and surgery. From 5 years and onwards, risk of death matched corresponding
Conclusion
Absolute survival for the patients in the present study is in good accordance to reported survival in the literature. This study indicates that the nodular stage in the postoperative pathological staging is a strong predictor for long time survival following surgical treatment for non-small cell lung cancer. Furthermore, the female gender per se exerts a significant positive effect on survival that is independent of alterations in life expectancy and co-mortality over time. There is no
Acknowledgements
The kind help offered by the staff at the Central Archives and others at Haukeland University Hospital is appreciated. The routine histopathological examinations have been performed at the Dept. of Pathology, Haukeland University Hospital.
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