The Impact of Sex on Survival in Patients with Non-Small Cell Lung Cancer
Date
2023-01-16
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Abstract
Background Lung cancer is the leading cause of cancer-related mortality in Canada and globally. Non-small cell lung cancer (NSCLC) is the most common histological subtype of the disease in Canada, with several known prognostic factors. There is growing evidence of the role of sex in NSCLC survival, which is of great clinical and population health interest. The aim of this study was to assess the impact of sex on survival in a real-world population of Canadian NSCLC patients. Methods Retrospective cohort studies were completed using real-world data from the Glans-Look Lung Cancer Research database (GLR). The analyses included patients diagnosed with NSCLC between 2010 and 2020 in Alberta, Canada. The primary study analyzed 10,849 NSCLC patients, where the secondary study analyzed 627 NSCLC patients who tested positive for specific biomarkers and were treated with targeted or immunotherapy. Descriptive statistics were used for cohort characterization, with basic survival analyses completed with Kaplan-Meier estimates and log rank tests. Cox proportional hazards models were utilized for univariable and multivariable analyses. Results In the primary analysis, there was a significant association between male sex and increased hazard of death. The unadjusted and adjusted hazard ratios (HR) for male sex were 1.32 (95% CI 1.26-1.37) and 1.28 (95% CI 1.23-1.34), respectively. The effect of sex remained among advanced stage patients (Stage 4 adjusted HR: 1.26, 95% CI: 1.19 – 1.33). In the secondary analysis, there was no survival differences by sex for the total, ALK mutated, and PD-L1 high expression cohorts. The EGFR cohort found a crude HR for male sex of 1.24 (95% CI: 1.01 – 1.54), but the significance of the association disappeared in the adjusted model 1.30 (95% CI: 0.94 – 1.82). Conclusions In this population-based Canadian cohort, females with NSCLC tended to have longer survival than males with NSCLC, after accounting for the effect of known prognostic factors. There is suggestion of differences in this association based on biomarker status. Future research should focus on examining potential biological and behavioural based explanations for the female survival advantage in NSCLC.
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Keywords
non-small cell lung cancer, survival, sex
Citation
Ford-Sahibzada, C. A. (2023). The impact of sex on survival in patients with non-small cell lung cancer (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.