Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, United States.
University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109-2029, United States.
Lung Cancer. 2022 Sep;171:115-120. doi: 10.1016/j.lungcan.2022.07.015. Epub 2022 Aug 1.
Low dose computed tomography (LDCT) became the standard method for lung cancer (LC) screening in 2013. However, it is unclear whether there are differences in survival rates based on sex and whether the differences depend on screening status. We aimed to evaluate the LC survival rates between females and males based on screening.
This retrospective cohort study examined data from the Boston LC Study (BLCS) between 2013 and 2021. LC screening depends on patients' demographics (age and smoking history) to determine whether a person is a high-risk individual and, therefore, undergo LDCT. Descriptive statistics were calculated for race, age, histology, smoking history, stage, and treatment. These variables' distributions were compared between sex and screening status using t-test and chi-square, respectively. Cox proportional hazards model and Kaplan-Meier curves were used to compare survival between sex and screening. Propensity score matching was applied to account for selection bias in screening when evaluating the association between screening and stage.
A total of 1,216 LC patients were identified with a screening incidence of 9.4 %, among whom 56 % were female. Unscreened males had 1.59 times higher risk of mortality than unscreened females (P=.0002) and had a worse 5-year survival (male 50 %; 95 %CI, 0.38,0.6 vs female 70 %; 95 %CI,0.62,0.76). In contrast, there were no significant differences in survival between sexes among screened. In a balanced cohort of screened and unscreened, the odds of being diagnosed at late stages for females and smokers were 1.33 and 2.51 times that of males and nonsmokers; however, there were no statistical significance.
Unscreened females had a lower risk of mortality and better survival than unscreened males, while among the screened population, there was no difference in the overall survival. These observations demonstrate the influence of sex on survival prognosis in LC when screening is not performed.
低剂量计算机断层扫描（LDCT）于 2013 年成为肺癌（LC）筛查的标准方法。然而，目前尚不清楚生存率是否因性别而异，以及这些差异是否取决于筛查状态。我们旨在评估基于筛查的女性和男性 LC 生存率。
本回顾性队列研究分析了 2013 年至 2021 年波士顿 LC 研究（BLCS）的数据。LC 筛查取决于患者的人口统计学特征（年龄和吸烟史），以确定一个人是否为高危个体，因此是否进行 LDCT。计算了种族、年龄、组织学、吸烟史、分期和治疗的描述性统计数据。使用 t 检验和卡方检验分别比较了性别和筛查状态下这些变量的分布。使用 Cox 比例风险模型和 Kaplan-Meier 曲线比较了性别和筛查之间的生存情况。应用倾向评分匹配来校正筛查时的选择偏倚，以评估筛查与分期之间的关联。
共确定了 1216 例 LC 患者，筛查发生率为 9.4%，其中 56%为女性。未筛查的男性死亡率比未筛查的女性高 1.59 倍（P=.0002），5 年生存率也较差（男性 50%；95%CI，0.38，0.6 vs 女性 70%；95%CI，0.62，0.76）。相比之下，在筛查组中，男女之间的生存率没有显著差异。在平衡的筛查和未筛查队列中，女性和吸烟者被诊断为晚期的几率是男性和非吸烟者的 1.33 倍和 2.51 倍；然而，这并没有统计学意义。
未筛查的女性死亡率较低，生存率较高，而在筛查人群中，整体生存率没有差异。这些观察结果表明，在未进行筛查的情况下，性别对 LC 生存预后有影响。
