Female gender is an independent predictor of superior perioperative survival following non-small cell lung cancer (NSCLC) resection

Abstract

7150 Background: Selecting patients who will benefit from surgical resection of NSCLC, especially following induction therapy, can be challenging. We analyzed our modern experience to determine factors associated with superior operative outcomes. Methods: A retrospective review of a prospectively maintained database of consecutive NSCLC patients who underwent surgical exploration for resection from January 1999 through June 2005 was performed. Factors evaluated included age, sex, co-morbidities, use of induction therapy, previous thoracic operations, extent of lung resection, and in-hospital mortality. Associations between categorical variables were evaluated with a chi-squared test and for continuous variables with an analysis of variance. Multivariate analysis was done with a logistic regression model. Results: A total of 2,524 patients underwent attempt at surgical resection, 1,398 of whom were female (55.4%). One hundred and four (4.1%) patients had exploration only. The majority of patients underwent lobectomy (1,692/2,524, 67.1%), and 6.1% (154/2,524) had a pneumonectomy. Induction therapy was given in 492 patients (19.5%). Univariate analysis showed that male gender (2.4% vs 0.93%, respectively, p = 0.003), presence of cardiac co-morbidity (p = 0.05), poor diffusion capacity (p = 0.003), and greater extent of resection (p = 0.01) were associated with increased in-hospital mortality. Multivariate analysis controlling for gender, age, diffusion capacity, cardiac, and diabetic co-morbidity, as well as prior lung cancer operation, extent of resection and use of induction therapy demonstrated that increased age, decreased diffusion capacity and greater anatomic lung resection were risk factors for higher in-hospital mortality. However, female sex was an independent predictor of lower in-hospital mortality (OR 0.41, p = 0.01). Conclusions: In addition to other previously described predictors of poor surgical outcome, such as advanced age, poor lung function and greater extent of lung removal, we observed that female gender appears to be associated with better in-hospital survival following surgical resection of NSCLC. No significant financial relationships to disclose.