Heart Center, Turku University Hospital, Turku, Finland.
Department of Surgery, University of Turku, Turku, Finland.
Interact Cardiovasc Thorac Surg. 2021 May 27;32(6):889-895. doi: 10.1093/icvts/ivab006.
Surgery is the standard treatment in early-stage non-small-cell lung cancer and select cases of small-cell lung cancer, but gender differences in its use and outcome are poorly known. Gender differences in surgical resection rates and long-term survival after lung cancer surgery were therefore investigated.
In Finland, 3524 patients underwent resection for primary lung cancer during 2004-2014. Surgical rate and mortality data were retrospectively retrieved from 3 nationwide compulsory registries. Survival was studied by comparing propensity-matched cohorts. Median follow-up was 8.6 years.
Surgery rate was higher in women (15.9% vs 12.3% in men, P < 0.0001). Overall survival was 85.3% 1 year, 51.4% 5 years, 33.4% 10 years and 24.2% at 14 years from surgery. In matched groups, survival after resection was better in women after 1 year (91.3% vs 83.3%), 5 years (60.2% vs 48.6%), 10 years (43.7% vs 27.9%) and 14 years (29.0% vs 21.1%) after surgery [hazard ratio (HR) 0.66; confidence interval (CI) 0.58-0.75; P < 0.0001]. Of all first-year survivors, 39.1% were alive 10 years and 28.3% 14 years after surgery. Among these matched first-year survivors, women had higher 14-year survival (36.9% vs 25.3%; HR 0.75; CI 0.65-0.87; P = 0.0002).
Surgery is performed for lung cancer more often in women. Women have more favourable short- and long-term outcome after lung cancer surgery. Gender discrepancy in survival continues to increase beyond the first year after surgery.
手术是早期非小细胞肺癌和小细胞肺癌的标准治疗方法，但手术的使用和结果存在性别差异，这一点尚不清楚。因此，研究了肺癌手术后手术切除率和长期生存的性别差异。
在芬兰，2004 年至 2014 年间，有 3524 名患者接受了原发性肺癌切除术。从 3 个全国性强制登记处回顾性检索手术率和死亡率数据。通过比较倾向匹配队列来研究生存情况。中位随访时间为 8.6 年。
女性的手术率较高（女性为 15.9%，男性为 12.3%，P<0.0001）。手术后 1 年、5 年、10 年和 14 年的总生存率分别为 85.3%、51.4%、33.4%和 24.2%。在匹配组中，女性手术后 1 年（91.3% vs 83.3%）、5 年（60.2% vs 48.6%）、10 年（43.7% vs 27.9%）和 14 年（29.0% vs 21.1%）的生存情况更好[风险比（HR）0.66；置信区间（CI）0.58-0.75；P<0.0001]。所有第一年存活的患者中，有 39.1%在手术后 10 年和 28.3%在手术后 14 年存活。在这些匹配的第一年存活患者中，女性 14 年的生存率更高（36.9% vs 25.3%；HR 0.75；CI 0.65-0.87；P=0.0002）。
女性更常因肺癌进行手术。女性肺癌手术后的短期和长期预后更好。手术后第一年的生存性别差异持续增加。
