Non-Small-Cell Lung Carcinoma in Women: A Retrospective Cohort Study in Indonesia

Noorwati Sutandyo, Eddy Suratman


Background: the increasing incidence of lung cancer in female patients has been observed in Indonesia. Lung cancer in female might have different biology process than male, but it has never been evaluated in Indonesia. This study aimed to know characteristics and survival of female patients with non-small-cell lung carcinoma (NSCLC) in Dharmais National Cancer Centre Hospital. Methods: a retrospective cohort study was performed among NSCLC female patients in Dharmais Cancer Hospital (DCH) between January 2005 and December 2015. Survival analysis was done using the Kaplan-Meir estimation curve with proportional assumption test. Independent prognostic factors were analyzed using the Cox proportional hazard model with a hazard ratio (HR) and its 95% confidence interval (CI). Results: a total of 956 NSCLC cases were retrieved during the study; 268 (28.0%) were female patients. Mean of age in female patients was 56.9 (11.87) years old. Among female patients, 21 (7.8%) were smokers, 244 (91.1%) had adenocarcinoma subtype, and 261 (98.0%) were in advanced stage (III-IV). Median survival was slightly longer in female than male patients (14.9 months vs. 12.2 months; log-rank p=0.055). Significant prognostic factors for survival were older age (>50 y.o) (HR = 0.681; 95% CI = 0.467 – 0.992; p= 0.045) and positive eGFR mutation (HR = 0.393; 95% CI = 0.251 – 0.615; p<0.001). Conclusion: female patients contributed to about 28% of all NSCLC cases. They were mostly non-smokers, have more adenocarcinoma histopathology and eGFR mutation. Survival tended to be longer in female than male patients. Age over 50 years and the presence of eGFR mutation were good prognostic factors to survival in female lung cancer patients.


adenocarcinoma; EGFR mutation; female non-smoker; overall survival; non-small cell lung carcinoma


International Agency for Research on Cancer. Lung cancer: estimated incidence, mortality, and prevalence worldwide in 2012. Available at

American Cancer Society. Key statistics for lung cancer. Available at

Jemal A, Ward E, Thun MJ. Contemporary lung cancer trends among US women. Cancer Epidemiol Biomarkers Prev. 2005;14:582-5.

American Cancer Society. Cancer Facts and Figures 2017.

Patel JD, Bach PB, Kris MG. Lung cancer in US women: a contemporary epidemic. JAMA. 2004;291:1763-8.

Kligerman S, White C. Epidemiology of lung cancer in women: risk factors, survival, and screening. AJR. 2011;196:287-95.

Radzikowska E, Glaz P, Roszkowski K. Lung cancer in women: age, smoking, histology, performance status, stage, initial treatment and survival – Population-based study of 20,561 cases. Ann Oncol. 2002;13:1087-93.

Badar F, Meerza F, Khokhar RA, et al. Characteristics of lung cancer patients--the Shaukat Khanum Memorial experience. Asian Pac J Cancer Prev. 2006;7:245-8.

Katcoff H, Wenzlaff AS, Schwartz AG. Survival in women with NSCLC: the role of reproductive history and hormone use. J Thorac Oncol. 2014;9:355-61.

Wang P, Zou J, Wu J, et al. Clinical profiles and trend analysis of newly diagnosed lung cancer in a tertiary care hospital of East China during 2011-2015. J Thorac Dis. 2017;9:1973-9.

Remon J, Isla D, Garrido P, et al. Efficacy of tyrosine kinase inhibitors in EGFR-mutant lung cancer women in a real-world setting: the WORLD07 database. Clin Transl Oncol. 2017 (in press).

Jenks S. Is lung cancer incidence increasing in never smokers? J Natl Cancer Inst. 2016;108:3-4.

Deng F, Li M, Shan W-L, et al. Correlation between epidermal growth factor receptor mutations and the expression of estrogen receptor-b in advanced non-small cell lung cancer. Oncol Lett. 2017;13:2359-65.

Sobue T, Yamamoto S, Hara M, Sasazuki S, Sasaki S, Tsugane S. Cigarette smoking and subsequent risk of lung cancer by histologic type in middle-aged Japanese men and women: the JPHC study. Int J Cancer. 2002;99:245-51.

Toh C-K, Wong E-H, Lim W-T, et al. The impact of smoking status on the behavior and survival outcome of patients with advanced non-small cell lung cancer: A retrospective analysis. Chest. 2004;126:1750-6.

Yu Y, Liu H, Zheng S, et al. Gender susceptibility for cigarette smoking-attributable lung cancer: a systematic review and meta-analysis. Lung Cancer. 2014;85:351-60.

Bain C, Feskanich D, Speizer FE, et al. Lung cancer rates in men and women with comparable histories of smoking. J Natl Cancer Inst. 2004;96:826-34.

Powell HA, Iyen-Omofoman B, Hubbard RB, Baldwin DR, Tata LJ. The association between smoking quantity and lung cancer in men and women. Chest. 2013;143:123-9.

Thomas L, Doyle A, Edelman MJ. Lung cancer in women: emerging differences in epidemiology, biology and therapy. Chest. 2005;128:370-81.

Wakalee HA, Chang ET, Gomez SL, et al. Lung cancer incidence in never smokers. J Clin Oncol. 2007;25:472-8.

Chakraborty S, Ganti AK, Marr A, Batra SK. Lung cancer in women: role of estrogen. Expert Rev Respir Med. 2010;4:509-18.

Siegfried JM, Hershberger PA, Stabile LP. Estrogen receptor signaling in lung cancer. Semin Oncol. 2009; 36:524-31.

Stabile LP, Davis G, Gubish CT, et al. Human non-small-cell lung tumours and cells derived from normal lung express both estrogen receptor a and b and show biological responses to estrogen. Cancer Res. 2002;62:2141-50.

Stabile LP, Dacic S, Land SR, et al. Combined analysis of estrogen receptor beta-1 and progesterone receptor expression identifies lung cancer patients with poor outcome. Clin Cancer Res. 2010;17:154-64.

Kazmi N, Márquez-Garbán DC, Aivazyan L, Garon EB, Goodglick L, Pietras RJ. The role of estrogen, progesterone and aromatase in human non-small-cell lung cancer. Lung Cancer Manag. 2012; 1:259-72.

Mah V, Seligson DB, Li A, et al. Aromatase expression predicts survival in women with early-stage non-small cell lung cancer. Cancer Res. 2007; 67:10484-90.

Chlebowski RT, Schwartz AG, Anderson GL, et al. Oestrogen plus progestin and lung cancer in postmenopausal women (Women’s Health Initiative trial): a post-hoc analysis of a randomised controlled trial. Lancet. 2009;374:1243-51.

Slatore CG, Chien JW, Au DH, et al. Lung cancer and hormone replacement therapy: association in the vitamins and lifestyle study. J Clin Oncol. 2010;28:1540-6.

Moore R, Doherty D, Chamberlain R, Khuri F. Sex differences in survival in non-small cell lung cancer patients 1974-1998. Acta Oncol. 2004;43:57-64.

Oton AB, Belani C, Owonikoko T, et al. Comparison of survival for non-small cell lung cancer between premenopausal and postmenopausal women: an analysis of the National Surveillance, Epidemiology and End Results (SEER) Database. J Clin Oncol (Meeting Abstr) 2006;24:7038.

Moore KA. Menopausal effects on presentation, treatment, and survival of women with non-small cell lung cancer. Ann Thorac Surg. 2003;76(6):1789–95.

Viñolas N, Garrido P, Isla D, et al. Lung cancer in never-smoking women: A sub-analysis of the Spanish Female-Specific Database WORLD07. Cancer Invest. 2017;35(5):358–65.

Mok TS, Wu YL, Thongprasert S, Yang CH, Chu D, Saijo N. Phase III, randomized, open-label, first-line study of gefitinib (G) versus carboplatin/paclitaxel (C/P) in clinically selected patients (pts) with advanced non-small-cell lung cancer (NSCLC). Ann Oncol. 2008;19.viii1-viii4.

Full Text: PDF


  • There are currently no refbacks.