Ann Thorac Surg 2005;80:790
© 2005 The Society of Thoracic Surgeons
Correspondence
Reply
Kimberly A. Moore, MD,
Michael T. Jaklitsch, MD,
Jeanne M. Lukanich, MD
Division of Thoracic Surgery Department of General Surgery Brigham and Women’s Hospital 75 Francis St Boston, MA& 02115 USA
(Email: kmoore7{at}partners.org).
To the Editor:
We appreciate the comments made by Dr Birdas. In Table 6 of our paper [1], we demonstrated that premenopausal women had a survival advantage over postmenopausal women in adjusted overall and lung cancer-related mortality for all stages, and adjusted disease-specific mortality for early stage disease. In the same table, older men were similarly compared to premenopausal women. From the hazard ratios (HR) of men and women aged 51 to 70 years compared with premenopausal women, we extrapolated that postmenopausal women had a lower incidence of lung cancer-related deaths than older men for all stages (HR 1.14 vs 1.26) and early stage disease (HR 1.28 vs 1.38). Our Kaplan-Meier estimates indeed demonstrated a survival advantage of postmenopausal women over older men (p < 0.001). It is true that the 95% confidence intervals (CIs) overlap between postmenopausal women and older men as compared to premenopausal women, but that does not statistically negate the difference in outcomes between postmenopausal women and older men when compared to the premenopausal group. We agree with Dr Birdas that one clear interpretation of these data are that patients older than 51 years did worse compared to those younger than 51 years irrespective of gender, and that much of this difference is likely due to the biology of cancer in older patients. We remain satisfied, however, that we have identified an additional effect that seems linked to menopausal status. What is unclear is precisely how estrogen exposure may impact the biology of non-small cell lung cancer and its outcomes. This warrants further investigation.
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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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