Ann Thorac Surg 2005;80:789-790
© 2005 The Society of Thoracic Surgeons
Correspondence
Menopausal Status and Non-Small Cell Lung Cancer
Thomas J. Birdas, MD
Department of Cardiothoracic Surgery Allegheny General Hospital 320 E North Ave, South Tower, 14th Floor Pittsburgh, PA 15212 USA
(Email: tbirdas1{at}aol.com).
To the Editor:
In a very interesting paper, Moore and colleagues [1] examine the possible effects of menopause on the presentation and outcomes of non-small cell lung cancer. They conclude that postmenopausal women, defined as women older than 51 years, have a worse prognosis compared to premenopausal ones. The use of age as a proxy for menopause status was a necessity of the study design, as the authors explain. It introduces, however, the significant confounding factor of age; indeed older men also had a significantly worse prognosis compared to younger men. The authors attempt to support their conclusion by stating that postmenopausal women maintained a survival advantage compared to their male counterparts, while men and women in the younger age groups had essentially the same prognosis. Unfortunately, such an assumption cannot be made based on the data included in the manuscript. While older women did experience increased survival compared to older men in univariate analysis, this difference was not evident in multivariate analysis (Table 6 in the manuscript), as the 95% confidence intervals of the reported hazard ratios overlapped for all stages and both in overall and disease-specific mortality. The only conclusion that can be reached from the published data is that patients older than 51 years did worse compared to those younger than 51 years, regardless of gender, although there was a trend for women to do better than men. Perhaps the inclusion of age as an independent continuous variable and the comparison of its effects in men and women might reveal a more significant difference, aided by the large sample size of the study. This topic is an extremely important one, and large observational studies such as the one by Moore and colleagues [1] can lead to new ideas and developments in the management of non-small cell lung cancer.
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References
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- Moore KA, Mery MCM, Jaklitsch MT, et al. Menopausal effects on presentation, treatment, and survival of women with non-small cell lung cancer Ann Thorac Surg 2003;76:1789-1795.[Abstract/Free Full Text]
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