Hormone replacement therapy and outcomes for women with non-small-cell lung cancer: can an association be confirmed?

A recent report suggested that women who had been taking hormone replacement therapy (HRT) experienced significantly decreased survival after a lung cancer diagnosis. Given the large cohort of women who have received HRT, it is important to try to confirm that association.

We reviewed female patients diagnosed with lung cancer at our institution between January 1999 and December 2003 for age at diagnosis, disease stage, treatment, smoking history, hrt, performance status, weight loss, age at menopause, and overall survival. Patients were excluded if they had small-cell lung cancer or an unknown primary cancer, or if they had had previous or synchronous non-lung, non-skin cancers. Statistical analysis used the chi-square test for categorical variables and the Kaplan-Meier method and Cox regression model for univariate and multivariate analyses of overall survival.

Of 397 eligible patients, most (68%) were stage iii or iv. The group included very few never-smokers (5%). The proportion of patients with experience of prior or current hrt was 29%, and no effect on overall survival was observed. Median survival was 13 months in the non-hrt group and 14 months in the hrt group. Significant factors predicting for overall survival included performance status, stage, and weight loss.

Stage, performance status, and weight loss are the most powerful predictors of survival for women with non-small-cell lung cancer. As compared with non-hrt users, patients with prior hrt use did not have inferior outcomes, failing to duplicate previously published results.