Gender influence on weight-loss pattern and survival of nonsmall cell lung carcinoma patients

Gender has recently emerged as a discriminating factor in nonsmall lung carcinoma (NSCLC) patient outcome. Since the potential for interaction among established prognostic factors and gender in this common disease has not been explored, the authors evaluated the role of gender and weight-loss pattern in predicting clinical outcome in a balanced population of men and women presenting with NSCLC.From a tumor registry population of 368 NSCLC patients, a gender-balanced sample of 152 cases was randomly selected for review, using prospective inclusion criteria. Study parameters were age, race, tobacco and alcohol history, gender, weight-loss pattern, histology, TNM stage, Eastern Cooperative Oncology Group performance status, and therapy. Influences of study variables on Kaplan-Meier estimates of survival were subsequently determined using univariate and multivariate analyses.Overall median survival after diagnosis was significantly shorter for men with NSCLC than for women with the disease (40 vs. 78 weeks, P = 0.001). Men lost significantly more weight over their disease course than women (12.2 vs. 5.4 pounds, P = 0.006) and experienced an eightfold faster rate of initial weight loss (0.25 vs. 0.03 pounds per week, P = 0.001). In multivariate analysis, the strongest independent predictors of NSCLC patient survival were stage of disease, initial weight-loss rate, and gender (all P < 0.0001).These results suggest that weight loss may play a role in mediating gender-related differences in NSCLC patient survival and provide an impetus for further studies of gender influence on cancer outcome.