Sex differences persist across surgical treatments in early-stage non–small cell lung cancer

Abstract

Objective

Sex-based overall survival in patients with early-stage non–small cell lung cancer who undergo surgery is not well characterized. Existing data are limited by small sample sizes and underrepresentation of female patients or do not address overall survival according to surgical approach. The objective of this study was to compare overall survival among female and male patients with early-stage non–small cell lung cancer who underwent surgery.

Methods

Data were extracted from the National Cancer Database for all patients diagnosed with clinical stage I-IIB non–small cell lung cancer who underwent surgical resection from 2009 to 2018, had R₀ margins, and had at least 10 lymph nodes sampled for metastasis. Overall survival of the study sample was evaluated based on sex using multivariable Cox proportional hazards modeling and propensity score–matched analysis.

Results

Of the 79,209 patients included in the study sample, 43,218 (54.6%) were female. A propensity score–matched analysis of 23,988 female and 23,988 male patients with early-stage non–small cell lung cancer who underwent surgery showed that the female group had significantly improved 5-year overall survival at 71.2% (95% CI, 70.5-71.8) compared with the male group at 61.7% (95% CI, 61.0-62.4) (log-rank, P < .0001).

Conclusions

Female patients with early-stage non–small cell lung cancer who underwent surgery had significantly better overall survival at 5 years when compared with their male counterparts.