Philpott Holly T, Murphy Rowan, McCausland Cassidy, Gao Yingtong, Anstee Caitlin, Gingrich Molly, Seely Andrew, Wallace Alison
Department of Surgery, Division of Thoracic Surgery, Dalhousie University, Halifax, NS, B3H 2Y9, Canada.
Department of Surgery, Division of Thoracic Surgery, University of Ottawa, The Ottawa Hospital, Ottawa, ON, K1H 8L6, Canada.
Eur J Cardiothorac Surg. 2025 Jul 1;67(7). doi: 10.1093/ejcts/ezaf236.
Sex differences in perioperative outcomes following lung cancer surgery remain understudied. This study evaluated these differences in a national cohort.
Data for patients who underwent lung cancer surgery between January 2017-December 2022 at 13 hospitals were extracted from the Canadian Association of Thoracic Surgeons National Database. Preoperative characteristics, surgery-related, tumour-related, and postoperative outcomes data were collected. Mixed-effects logistic regression models were used to determine perioperative variables associated with female sex.
A total of 9922 patients were included, and 55.4% were female. Female patients had higher rates of minor complications, lower rates of major complications, and lower mortality. Females were less likely to be active smokers (odds ratio [OR] = 0.66; 95% confidence interval [CI], 0.52, 0.83), have comorbidities, have squamous cell carcinoma (OR = 0.34; 95% CI, 0.26, 0.44), or an air leak complication postoperatively (OR = 0.66; 95% CI, 0.51, 0.86). However, females with chronic obstructive pulmonary disease (COPD) or squamous cell carcinoma had higher odds of experiencing an air leak complication postoperatively.
Females had fewer comorbidities, less advanced stage cancer, less pulmonary resection, and different tumour types, all leading to lower rates of major complications and mortality compared to males. Understanding preoperative factors that contribute to sex differences in adverse events can enhance the short- and long-term outcomes for patients with lung cancer.
肺癌手术后围手术期结局的性别差异仍未得到充分研究。本研究在全国队列中评估了这些差异。
从加拿大胸外科医师协会国家数据库中提取了2017年1月至2022年12月期间在13家医院接受肺癌手术的患者数据。收集了术前特征、手术相关、肿瘤相关和术后结局数据。使用混合效应逻辑回归模型来确定与女性性别相关的围手术期变量。
共纳入9922例患者，其中55.4%为女性。女性患者的轻微并发症发生率较高，严重并发症发生率较低，死亡率也较低。女性当前吸烟者较少（优势比[OR]=0.66；95%置信区间[CI]，0.52，0.83），合并症较少，患鳞状细胞癌的可能性较小（OR=0.34；95%CI，0.26，0.44），术后发生漏气并发症的可能性也较小（OR=0.66；95%CI，0.51，0.86）。然而，患有慢性阻塞性肺疾病（COPD）或鳞状细胞癌的女性术后发生漏气并发症的几率较高。
与男性相比，女性的合并症较少，癌症分期较晚，肺切除较少，肿瘤类型不同，所有这些导致严重并发症和死亡率较低。了解导致不良事件性别差异的术前因素可以改善肺癌患者的短期和长期结局。
