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J Thorac Cardiovasc Surg 2009;137:807-812
© 2009 The American Association for Thoracic Surgery

General Thoracic Surgery

Gender difference in survival of resected non–small cell lung cancer: Histology-related phenomenon?

^a Cheju National University Hospital, School of Medicine, Cheju National University, Jeju, South Korea
^b Division of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan

Received for publication March 23, 2008; revisions received August 25, 2008; accepted for publication September 12, 2008.

^_* Address for reprints: Hisao Asamura, MD, Division of Thoracic Surgery, National Cancer Center Hospital 1-1, Tsukiji 5-chome, Chuo-ku, Tokyo 104-0045, Japan. (Email: hasamura{at}ncc.go.jp).

Objective: It remains controversial whether there is a gender difference in survival of patients with resected non–small cell lung cancer.

Methods: We retrospectively analyzed 2770 patients (1689 men and 1081 women) with non–small cell lung cancer who underwent pulmonary resection between 1995 and 2005 at the National Cancer Center Hospital, Tokyo. A gender difference in survival was studied in all patients, in those divided according to histology or pathologic stage, and in propensity-matched gender pairs.

Results: There were no differences in background, such as preoperative pulmonary function, operation procedures, or operative mortality. The proportions of adenocarcinoma and pathologic stage I in women were greater than those in men (93.6% vs 61.7% and 71.4% vs 58.6%, respectively) (P < .001). Overall 5-year survival of women was better than that of men (81% vs 70%, P < .001). In adenocarcinoma, the overall 5-year survival for women was better than that for men in pathologic stage I (95% vs 87%, P < .001) and in pathologic stage II or higher (58% vs 51%, P = .017). In non-adenocarcinoma, there was no significant gender difference in survival in pathologic stage I (P = .313) or pathologic stage II or higher (P = .770). The variables such as age, smoking status, histology, and pathologic stage were used for propensity score matching, and survival analysis of propensity score-matched gender pairs did not show a significant difference (P = .69).

Conclusion: Women had better survival than men; however, there was no survival advantage in propensity-matched gender pairs. A gender difference in survival was observed only in the adenocarcinoma subset, suggesting pathobiology in adenocarcinoma in women might be different from that of men.