Survival in women with NSCLC: the role of reproductive history and hormone use.
BACKGROUND
Although lung cancer is the leading cause of cancer death in women, few studies have investigated the hormonal influence on survival after a lung cancer diagnosis and results have been inconsistent. We evaluated the role of reproductive and hormonal factors in predicting overall survival in women with non-small-cell lung cancer (NSCLC).


METHODS
Population-based lung cancer cases diagnosed between November 1, 2001 and October 31, 2005 were identified through the Metropolitan Detroit Surveillance, Epidemiology, and End Results Registry. Interview and follow-up data were collected for 485 women. Cox proportional hazard regression models were used to determine hazard ratios (HRs) for death after an NSCLC diagnosis associated with reproductive and hormonal variables.


RESULTS
Use of hormone therapy (HT) was associated with improved survival (HR, 0.69; 95% confidence interval, 0.54-0.89), adjusting for stage, surgery, radiation, education level, pack-years of smoking, age at diagnosis, race, and a multiplicative interaction between stage and radiation. No other reproductive or hormonal factor was associated with survival after an NSCLC diagnosis. Increased duration of HT use before the lung cancer diagnosis (132 months or longer) was associated with improved survival (HR, 0.54; 95% confidence interval, 0.37-0.78), and this finding remained significant in women taking either estrogen alone or progesterone plus estrogen, never smokers, and smokers.


CONCLUSIONS
These findings suggest that HT use, in particular use of estrogen plus progesterone, and long-term HT use are associated with improved survival of NSCLC.
*Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; and †Karmanos Cancer Institute, Department of Oncology, Wayne State University School of Medicine, Detroit, Michigan.
Hannah
H
Katcoff
Angela S
AS
Wenzlaff
Ann G
AG
Schwartz
D000230:Adenocarcinoma / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D000328:Adult; D000368:Aged; D018287:Carcinoma, Large Cell / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy / Q000009:adverse effects / Q000401:mortality*; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology / Q000401:mortality* / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D017584:Reproductive History; D015996:Survival Rate