Quanto às diferenças nos dois períodos avaliados (de 1990 a 2000 e de 2001 a 2009) houve aumento da porcentagem de pacientes do gênero feminino, no segundo período. Esta tendência também se observa no Brasil,18 provavelmente em conseqüência a que o hábito do tabagismo entre as mulheres vem crescendo cada vez mais.
O gênero feminino tem sido apontado como fator de risco para desenvolvimento de carcinoma brônquico, explicado pelo crescimento do tabagismo entre as mulheres e possível pré-disposição biológica para o desenvolvimento da doença.51-55
As diferenças de gênero associadas ao fator de desenvolvimento do câncer de pulmão e também aos índices de sobrevida, não são bem compreendidos. As mulheres parecem ser mais suscetíveis ao desenvolvimento de câncer de pulmão, apesar de em geral, fumarem menos e começarem mais tarde que os homens.93 Fatores hormonais podem estar envolvidos, sugerindo que o crescimento de células tumorais possam depender de hormônios reprodutivos.92 Esta hipótese é reforçada pela constatação de que CBNPC têm receptores de estrogênio em quantidade abundante, que diferem entre os vários tipos de carcinoma do pulmão e os estágios da doença.52
Em relação ao tipo histológico, a comparação entre os dois períodos do estudo não apresentou diferença estatisticamente significativa, apesar de ter sido notado aumento no número de adenocarcinomas. (P=0,243)
Quanto à sobrevida geral dos pacientes, houve aumento significativamente estatístico no período de 2001 a 2009 em relação ao período de 1990 a 2000 para a coorte plena. O efeito não permaneceu após atribuição de óbito para os pacientes censurados na coorte pior cenário.
Fator de proteção de sobrevida em gênero feminino não foi observado no período de 2001 a 2009. Entretanto, devido ao grande poder estatístico no período de 1990 a 2001, nas duas análises coortes, o efeito permanece na amostra geral.
A mesma situação é explicada para o gênero feminino em estágio I, onde a diferença entre os gêneros pertencentes a este estágio tem poder estatístico somente na coorte plena, do período de 1990 a 2000, permanecendo na amostra geral também, somente para esta coorte.
7 CONCLUSÕES
A partir do presente estudo, pode-se concluir que:
1. no grupo total de casos de CBNPC tratados cirurgicamente com intenção curativa, o gênero feminino esteve relacionado a maior sobrevida.
2. o efeito do gênero feminino em relação à mortalidade dos portadores de CBNPC, tratados cirurgicamente com intenção curativa, persistiu após ajuste para possíveis fatores de confusão (idade, tabagismo, anemia, estadiamento, tipo histológico da neoplasia, extensão da cirurgia e complicações pós-operatórias).
3. quando avaliados, conforme o estadiamento da neoplasia, a maior sobrevida do gênero feminino foi fator independente, apenas para pacientes em estágio I. Nos pacientes em estágio ≥ II, tal efeito não foi demonstrado.
4. houve aumento da porcentagem de mulheres tratadas cirurgicamente para CBNPC, no período de 2001 a 2009, em relação ao período de 1990 a 2000.
5. no segundo período de estudo (de 2001 a 2009), não houve diferença na estimativa das taxas de sobrevida entre os gêneros, tanto na amostra geral quanto para mulheres em estadiamento I.
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