Specific features of non-small cell lung cancer in women: a retrospective study of 1738 cases diagnosed in Bas-Rhin between 1982 and 1997.

INTRODUCTION: The literature suggests that lung cancer may represent a different disease in women compared with men and that gender specificities have been reported mostly in clinical trials patients.
METHODS: We conducted a retrospective, population-based study of a sample of 1738 patients diagnosed with a non-small cell lung cancer (NSCLC) in the department of Bas-Rhin (northeastern France) between 1982 and 1997. Our study aimed to describe symptoms at presentation, stage, histological distribution, treatment modalities, and survival, according to sex.
RESULTS: Tobacco exposure differed significantly according to sex: 28.9% of women were nonsmokers versus 1.4% of the men. More NSCLC were metastatic at diagnosis in women than in men (41.1% versus 29.9%). Adenocarcinoma predominated in women (54.4%), whereas squamous cell carcinoma predominated in men (65.9%). Invasive procedures, such as transthoracic needle biopsy, contributed more frequently to histological diagnosis in women. Men and women underwent the same procedures for disease staging, excepted for the abdominal computed tomography scan, which was performed more frequently in women. Treatment also differed: in resectable disease, fewer pneumonectomies were performed in women; in locally advanced disease, the mean doses of thoracic irradiation were significantly lower in women (48.0 grays versus 55.5 grays); in metastatic-stage disease, fewer women received platin-based chemotherapy, but this difference was not significant. Sex was not a significant prognostic factor in our study, contrary to most North American studies, where women seem to have had better survival rates.
CONCLUSIONS: This study emphasizes gender differences in smoking exposure, presentation (stage, histological subtype), and diagnostic and therapeutic management of NSCLC.