Sex differences in presentation, management, and prognosis of patients with non-small cell lung carcinoma

Objective and methods: To characterize gender differences in lung cancer, w e conducted a retrospective analysis including all patients undergoing surg ery for non-small cell lung carcinoma in a single institution over a 20-yea r period. Results: Compared with men (n = 839), women (n = 198) were more l ikely to be asymptomatic (32% vs 20%, P =.006), nonsmokers (27% vs 2%, P <. 001), or light smokers (31 pack-years vs 52 pack-years; P <.001), Squamous cell carcinoma predominated in men (65%), and adenocarcinoma predominated i n women (54%), Preoperative bronchoscopy contributed more frequently to a h istologic diagnosis in men (69% vs 49% in women, P <.001), and fewer pneumo nectomies were performed in women (22% vs 32% in men, P =.01). After multiv ariate Cox regression analysis, women survived longer than men (hazard rati o, 0.72; 95% confidence interval, 0.56-0.92; P =.009) independently of age, presence of symptoms, smoking habits, type of operation, histologic charac teristics, and stage of disease. The protective effect linked to female sex was present in early-stage carcinoma (stage I and II) and absent in more a dvanced-stage carcinoma (stage III and IV). Conclusions: This study emphasi zes strong sex differences in presentation, management, and prognosis of pa tients with non-small cell lung cancer.