晚期非小细胞肺癌生存的性别差异：一项丹麦全国性研究

IF 4.5 2区医学 Q1 ONCOLOGY

Lung Cancer Pub Date : 2025-03-07 DOI:10.1016/j.lungcan.2025.108485

Matilde Grupe Frost , Kristoffer Jarlov Jensen , Espen Jimenez-Solem , Camilla Qvortrup , Jon Alexander Lykkegaard Andersen , Tonny Studsgaard Petersen

{"title":"晚期非小细胞肺癌生存的性别差异：一项丹麦全国性研究","authors":"Matilde Grupe Frost , Kristoffer Jarlov Jensen , Espen Jimenez-Solem , Camilla Qvortrup , Jon Alexander Lykkegaard Andersen , Tonny Studsgaard Petersen","doi":"10.1016/j.lungcan.2025.108485","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Historically, cancers often exhibit sexual dimorphism. However, following the introduction of immune checkpoint inhibitors and targeted therapies into routine clinical practice, the association of sex on patient and tumour characteristics, as well as survival remains largely unexplored in advanced NSCLC.</div></div><div><h3>Patients and methods</h3><div>In this observational study, we identified adults diagnosed with advanced NSCLC from January 1, 2017, to December 31, 2023, using Danish nationwide health registries and clinical databases. We compared females to males across demographic, social, socioeconomic, patient and tumour characteristics (including PDL-1 expression and driver mutations), treatments, and overall survival (OS) from diagnosis and initiation of the first line of treatment (LOT1). Cox proportional hazards regression was employed, adjusting for key covariates in the overall cohort and stratified by stage, histological subtype, PD-L1 expression level, and treatment type. Propensity score matching was conducted as a sensitivity analysis.</div></div><div><h3>Results</h3><div>Among 14,635 included individuals, males comprised 50 % (n = 7,322). Patient and tumour characteristics differed between sexes. The crude and adjusted female-to-male mortality hazard ratio (HR) was 0·82 (95 % confidence interval [CI]: 0·79–0·85) and 0·84 (0·81–0·88) from diagnosis and 0·80 (0·76–0·84) and 0·80 (0·75–0·84) from initiation of LOT1. Median OS for females and males was 8·8 months (95 % CI 8·4–9·2) and 7·0 months (6·7–7·3) from diagnosis and 14·1 months (13·5–15·1) and 10·9 months (10·3–11·5) from initiation of LOT1. Stratified analyses revealed that across all strata, females consistently demonstrated either favourable or comparable outcomes compared to males.</div></div><div><h3>Conclusions</h3><div>This study increases our understanding of sex-based disparities in advanced NSCLC. Adjusted analyses addressing previously suggested explanations for sex disparities in survival still demonstrated a longer survival for females, indicating yet-unidentified sex differences with potential clinical implications. Our results underscore the critical role of acknowledging sex as a key variable in oncology trials, research, and clinical practice.</div></div>","PeriodicalId":18129,"journal":{"name":"Lung Cancer","volume":"202 ","pages":"Article 108485"},"PeriodicalIF":4.5000,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Sex disparities in advanced non-small cell lung cancer survival: A Danish nationwide study\",\"authors\":\"Matilde Grupe Frost , Kristoffer Jarlov Jensen , Espen Jimenez-Solem , Camilla Qvortrup , Jon Alexander Lykkegaard Andersen , Tonny Studsgaard Petersen\",\"doi\":\"10.1016/j.lungcan.2025.108485\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Historically, cancers often exhibit sexual dimorphism. However, following the introduction of immune checkpoint inhibitors and targeted therapies into routine clinical practice, the association of sex on patient and tumour characteristics, as well as survival remains largely unexplored in advanced NSCLC.</div></div><div><h3>Patients and methods</h3><div>In this observational study, we identified adults diagnosed with advanced NSCLC from January 1, 2017, to December 31, 2023, using Danish nationwide health registries and clinical databases. We compared females to males across demographic, social, socioeconomic, patient and tumour characteristics (including PDL-1 expression and driver mutations), treatments, and overall survival (OS) from diagnosis and initiation of the first line of treatment (LOT1). Cox proportional hazards regression was employed, adjusting for key covariates in the overall cohort and stratified by stage, histological subtype, PD-L1 expression level, and treatment type. Propensity score matching was conducted as a sensitivity analysis.</div></div><div><h3>Results</h3><div>Among 14,635 included individuals, males comprised 50 % (n = 7,322). Patient and tumour characteristics differed between sexes. The crude and adjusted female-to-male mortality hazard ratio (HR) was 0·82 (95 % confidence interval [CI]: 0·79–0·85) and 0·84 (0·81–0·88) from diagnosis and 0·80 (0·76–0·84) and 0·80 (0·75–0·84) from initiation of LOT1. Median OS for females and males was 8·8 months (95 % CI 8·4–9·2) and 7·0 months (6·7–7·3) from diagnosis and 14·1 months (13·5–15·1) and 10·9 months (10·3–11·5) from initiation of LOT1. Stratified analyses revealed that across all strata, females consistently demonstrated either favourable or comparable outcomes compared to males.</div></div><div><h3>Conclusions</h3><div>This study increases our understanding of sex-based disparities in advanced NSCLC. Adjusted analyses addressing previously suggested explanations for sex disparities in survival still demonstrated a longer survival for females, indicating yet-unidentified sex differences with potential clinical implications. Our results underscore the critical role of acknowledging sex as a key variable in oncology trials, research, and clinical practice.</div></div>\",\"PeriodicalId\":18129,\"journal\":{\"name\":\"Lung Cancer\",\"volume\":\"202 \",\"pages\":\"Article 108485\"},\"PeriodicalIF\":4.5000,\"publicationDate\":\"2025-03-07\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Lung Cancer\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0169500225003770\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Lung Cancer","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0169500225003770","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

摘要

历史上，癌症经常表现出性别二态性。然而，在常规临床实践中引入免疫检查点抑制剂和靶向治疗后，晚期NSCLC中性别与患者和肿瘤特征以及生存率的关系在很大程度上仍未被探索。在这项观察性研究中，研究人员使用丹麦全国健康登记处和临床数据库，从2017年1月1日至2023年12月31日确定了诊断为晚期非小细胞肺癌的成年人。我们从人口统计学、社会、社会经济、患者和肿瘤特征（包括PDL-1表达和驱动突变）、治疗和从诊断到开始一线治疗（LOT1）的总生存期（OS）对女性和男性进行了比较。采用Cox比例风险回归，调整整个队列中的关键协变量，并按分期、组织学亚型、PD-L1表达水平和治疗类型进行分层。倾向评分匹配作为敏感性分析。结果14635例个体中，男性占50% （n = 7322）。不同性别的患者和肿瘤特征不同。诊断后的粗死亡率和校正后的死亡率风险比（HR）分别为0.82（95%可信区间[CI]: 0.79 ~ 0.85）和0.84 (0.81 ~ 0.88)，LOT1开始后的死亡率风险比分别为0.80（0.76 ~ 0.84）和0.80（0.75 ~ 0.84）。女性和男性的中位生存期（OS）从诊断开始为8.8个月（95% CI为8.4 - 9.2）和7.0个月（6.7 - 7.3），从LOT1开始为14.1个月（13.5 - 15.1）和10.9个月（10.3 - 11.5）。分层分析显示，在所有阶层中，与男性相比，女性始终表现出有利或可比的结果。结论本研究增加了我们对晚期非小细胞肺癌性别差异的认识。调整后的分析解决了先前提出的性别生存差异的解释，仍然表明女性的生存时间更长，这表明尚未确定的性别差异具有潜在的临床意义。我们的结果强调了承认性别在肿瘤试验、研究和临床实践中是一个关键变量的关键作用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

Sex disparities in advanced non-small cell lung cancer survival: A Danish nationwide study

Background

Historically, cancers often exhibit sexual dimorphism. However, following the introduction of immune checkpoint inhibitors and targeted therapies into routine clinical practice, the association of sex on patient and tumour characteristics, as well as survival remains largely unexplored in advanced NSCLC.

Patients and methods

In this observational study, we identified adults diagnosed with advanced NSCLC from January 1, 2017, to December 31, 2023, using Danish nationwide health registries and clinical databases. We compared females to males across demographic, social, socioeconomic, patient and tumour characteristics (including PDL-1 expression and driver mutations), treatments, and overall survival (OS) from diagnosis and initiation of the first line of treatment (LOT1). Cox proportional hazards regression was employed, adjusting for key covariates in the overall cohort and stratified by stage, histological subtype, PD-L1 expression level, and treatment type. Propensity score matching was conducted as a sensitivity analysis.

Results

Among 14,635 included individuals, males comprised 50 % (n = 7,322). Patient and tumour characteristics differed between sexes. The crude and adjusted female-to-male mortality hazard ratio (HR) was 0·82 (95 % confidence interval [CI]: 0·79–0·85) and 0·84 (0·81–0·88) from diagnosis and 0·80 (0·76–0·84) and 0·80 (0·75–0·84) from initiation of LOT1. Median OS for females and males was 8·8 months (95 % CI 8·4–9·2) and 7·0 months (6·7–7·3) from diagnosis and 14·1 months (13·5–15·1) and 10·9 months (10·3–11·5) from initiation of LOT1. Stratified analyses revealed that across all strata, females consistently demonstrated either favourable or comparable outcomes compared to males.

Conclusions

This study increases our understanding of sex-based disparities in advanced NSCLC. Adjusted analyses addressing previously suggested explanations for sex disparities in survival still demonstrated a longer survival for females, indicating yet-unidentified sex differences with potential clinical implications. Our results underscore the critical role of acknowledging sex as a key variable in oncology trials, research, and clinical practice.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Lung Cancer 医学-呼吸系统

CiteScore

9.40

自引率

3.80%

发文量

407

审稿时长

25 days

期刊介绍： Lung Cancer is an international publication covering the clinical, translational and basic science of malignancies of the lung and chest region.Original research articles, early reports, review articles, editorials and correspondence covering the prevention, epidemiology and etiology, basic biology, pathology, clinical assessment, surgery, chemotherapy, radiotherapy, combined treatment modalities, other treatment modalities and outcomes of lung cancer are welcome.