Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
Chest. 2021 May;159(5):2029-2039. doi: 10.1016/j.chest.2020.11.010. Epub 2020 Nov 17.
Prior reports on a possible female survival advantage in both surgical and nonsurgical cohorts of patients with lung cancer are conflicting. Previously reported differences in survival after lung cancer surgery could be the result of insufficient control for disparities in risk factor profiles in men and women.
Do women who undergo pulmonary resections for lung cancer have a better prognosis than men when taking a wide range of prognostic factors into account?
We performed a nationwide population-based observational cohort study analyzing sex-specific survival after pulmonary resections for lung cancer. We identified 6356 patients from the Swedish National Quality Register for General Thoracic Surgery and performed individual-level record linkage to other national health-data registers to acquire detailed information regarding comorbidity, socioeconomic status, and vital status. Inverse probability of treatment weighting was used to account for differences in baseline characteristics. The association between female sex and all-cause mortality was assessed with Cox regression models, and flexible parametric survival models were used to estimate the absolute survival differences with 95% CIs. We also estimated the difference in restricted mean survival time.
We observed a lower risk of death in women compared with men (hazard ratio, 0.73; 95% CI, 0.67-0.79). The absolute survival difference at 1, 5, and 10 years was 3.0% (95% CI, 2.2%-3.8%), 10% (95% CI, 7.0%-12%), and 12% (95% CI, 8.5%-15%), respectively. The restricted mean survival time difference at 10 years was 0.84 year (95% CI, 0.61-1.07 years). The findings were consistent across several subgroups.
Women who underwent pulmonary resections for lung cancer had a significantly better prognosis than men. The survival advantage was evident regardless of age, common comorbidities, socioeconomic status, lifestyle factors, physical performance, type and extent of surgery, tumor characteristics, and stage of disease.
ClinicalTrials.gov; No.: NCT03567538; URL: www.clinicaltrials.gov.
先前关于肺癌手术和非手术患者中可能存在女性生存优势的报告相互矛盾。先前报告的肺癌手术后生存差异可能是由于对男性和女性的危险因素谱差异控制不足所致。
当考虑广泛的预后因素时，接受肺切除术治疗肺癌的女性是否比男性有更好的预后？
我们进行了一项全国范围内基于人群的观察性队列研究，分析了肺癌肺切除术后的性别特异性生存情况。我们从瑞典国家普通胸外科质量登记处确定了 6356 名患者，并进行了个体水平的记录链接，以获取有关合并症、社会经济状况和生存状态的详细信息。使用逆概率治疗加权来解释基线特征的差异。使用 Cox 回归模型评估女性性别与全因死亡率之间的关联，并使用灵活参数生存模型估计具有 95%置信区间的绝对生存差异。我们还估计了限制平均生存时间的差异。
我们观察到女性的死亡风险低于男性（风险比，0.73；95%置信区间，0.67-0.79）。在 1、5 和 10 年时的绝对生存差异分别为 3.0%（95%置信区间，2.2%-3.8%）、10%（95%置信区间，7.0%-12%）和 12%（95%置信区间，8.5%-15%）。10 年时限制平均生存时间的差异为 0.84 年（95%置信区间，0.61-1.07 年）。这些发现在几个亚组中是一致的。
接受肺切除术治疗肺癌的女性预后明显优于男性。生存优势无论年龄、常见合并症、社会经济状况、生活方式因素、身体机能、手术类型和范围、肿瘤特征和疾病分期如何都很明显。
ClinicalTrials.gov；编号：NCT03567538；网址：www.clinicaltrials.gov。
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