Effects of Sex on Mortality in Patients With Lung Cancer: A Multiple Mediation Analysis of The Boston Lung Cancer Study

IF 3.9 3区医学 Q2 ONCOLOGY

Clinical lung cancer Pub Date : 2026-03-01 Epub Date: 2025-09-24 DOI:10.1016/j.cllc.2025.09.007

Adriana Araceli Rodriguez Alvarez , Yuming Sun , Yi Li , David C. Christiani

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引用次数: 0

Abstract

Objective

Identify the specific variables that can explain the sex difference in lung cancer mortality.

Material and Methods

This retrospective cohort study analyzed data from the Boston Lung Cancer Study (1992-2022). We employed descriptive statistics, Wilcoxon rank-sum test, and Pearson’s Chi-square test to compare demographic and clinical variables by sex. Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate survival differences. Mediation analysis was conducted to investigate causal pathways through which sex influences mortality, incorporating cancer stage, smoking status, and treatment modalities.

Results

Among 7642 patients, 53.7% were women. Men were older, had heavier smoking histories, and more frequently received chemotherapy and radiotherapy, whereas women underwent more surgeries. Median survival was significantly longer for women (4.54 vs. 2.59 years), with a 29% reduced hazard of lung cancer–related death (HR: 0.71; 95% CI, 0.66-0.75; P < .0001). Approximately 32% of this survival difference was mediated by early-stage diagnosis, surgical intervention, and smoking history.

Conclusion

Women exhibited a survival advantage, of which only about one-third was explained by earlier diagnosis and higher surgical intervention rates. The remaining two-thirds of the mortality difference remains unexplained. Addressing these modifiable factors may reduce sex inequalities in lung cancer outcomes.

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性别对肺癌患者死亡率的影响：波士顿肺癌研究的多重中介分析

目的：确定能够解释肺癌死亡率性别差异的具体变量。材料和方法：本回顾性队列研究分析了波士顿肺癌研究（1992-2022）的数据。我们采用描述性统计、Wilcoxon秩和检验和Pearson卡方检验按性别比较人口学和临床变量。Kaplan-Meier生存曲线和Cox比例风险模型用于评估生存差异。进行中介分析以调查性别影响死亡率的因果途径，包括癌症分期、吸烟状况和治疗方式。结果：7642例患者中，女性占53.7%。男性年龄更大，吸烟史更重，更频繁地接受化疗和放疗，而女性则更多地接受手术。女性的中位生存期明显延长（4.54年vs 2.59年），肺癌相关死亡风险降低29% （HR: 0.71; 95% CI: 0.66-0.75; P < 0.0001）。大约32%的生存差异是由早期诊断、手术干预和吸烟史介导的。结论：女性表现出生存优势，其中只有约三分之一的原因是早期诊断和较高的手术干预率。其余三分之二的死亡率差异仍无法解释。解决这些可改变的因素可能会减少肺癌结局中的性别不平等。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical lung cancer 医学-肿瘤学

CiteScore

7.00

自引率

2.80%

发文量

159

审稿时长

24 days

期刊介绍： Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.