The new face of non-small-cell lung cancer in men: Results of two French prospective epidemiological studies conducted 10 years apart

Objectives: To evaluate the impact of epidemiological changes observed in 10 years in men with NSCLC on 1-year mortality; to compare prognosis factors of 1-year mortality according to gender.

Material and methods: The French College of General Hospital Respiratory Physicians conducted two prospective epidemiological multicentre studies at a 10-year interval (KBP-2000-CPHG and KBP-2010-CPHG). These studies included all adult patients with primary lung cancer histologically or cytologically diagnosed between 1(st) January and 31(st) December for the years 2000 and 2010, managed in the pneumology department of the participating hospitals. A standardised form was completed for each patient. A steering committee checked recruitment exhaustiveness. Vital status 1 year after diagnosis was collected.

Results: In 2000 and 2010 respectively, 137 and 104 centres included 3921 and 4597 men and 748 and 1486 women with NSCLC. In 2010 compared to 2000, male patients were older but had better performance status (PS); they were less frequently ever-smokers and heavy smokers; their cancer (usually diagnosed at advanced stage) was more often adenocarcinoma (p<0.0001). In 10 years, 1-year mortality has significantly decreased in men (from 61.2% to 56.6%, p<0.0001) and in women (from 58.1% to 50.9%, p<0.0001), but remained higher in men than in women leading to increased difference between men and women. Decreased 1-year mortality remained statistically significant after adjustment on age, PS, smoking, and histology (men: OR=0.81, 95% CI=0.73-0.90, p<0.0001; women: 0.71, 0.57-0.88, p<0.002). Active smoking was not a prognosis factor in men (OR=1.04, CI=0.79-1.37, p=0.78); age (>75 years) had less impact on mortality in men than in women (men: OR=1.43, CI=1.22-1.67, p ≤ 0.0001; women: OR=2.32, CI=1.71-3.15; p<0.0001).

Conclusions: The improved 1-year survival in 2010 as compared with 2000 was independent of age, smoking, PS, and histology, suggesting that it reflected new treatment and strategy efficacy. One-year mortality remains higher in men than in women.