Evaluating Prognostic Factors for Sex Differences in Lung Cancer Survival: Findings From a Large Australian Cohort

Yu, Xue Qin; Yap, Mei Ling; Cheng, Elvin S.; Ngo, Preston; Vaneckova, Pavla; Karikios, Deme; Canfell, Karen; Weber, Marianne

doi:10.1016/j.jtho.2022.01.016

Cited by 30 publications

(29 citation statements)

References 40 publications

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“…The sex differences in lung cancer demographics in our analysis were similar to those of other studies 9,11,12,25,26 . In our current study, the median age at diagnosis and the fact that the median age was lower in women was similar to that of previous studies 27,28 .…”

Section: Discussionsupporting

confidence: 91%

“…However, this study used a database before tyrosine kinase inhibitors were commonly used and excluded patients under the age of 45 years; these factors might contribute in part to the sex survival rate. In our study, since more than 70% of the patients (higher than that in other studies) had advanced disease (stage III or IV), this might have affected survival according to sex 12 …”

Section: Discussionmentioning

confidence: 49%

“…In our study, since more than 70% of the patients (higher than that in other studies) had advanced disease (stage III or IV), this might have affected survival according to sex. 12 EGFR mutation is common in women, 34 especially in never-smoker Asian women. 35 In our study, EGFR mutation was significantly twice as common in women with stage IV adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…However, factors such as age, smoking, clinical staging, and genetic mutation might have influence as confounding factors 10 . Recently, several studies have reported that after adjustment of these confounding factors, men continued to show poor prognosis compared to women 11,12 . However, large‐scale studies are sparse in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Sex differences in the characteristics and survival of patients with non‐small‐cell lung cancer: A retrospective analytical study based on real‐world clinical data of the Korean population

Jeon

Kim

et al. 2022

Thoracic Cancer

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Purpose This study aimed to investigate the differences in characteristics, clinical stages, treatment modalities, and survival outcomes in patients with non‐small‐cell lung cancer (NSCLC) based on sex differences using Korean nationwide registry data. Methods We analyzed the data of 8650 patients diagnosed with NSCLC between 2014 and 2017, obtained from the Korean Association for Lung Cancer Registry (KALC‐R). The Cox proportional hazard model was used to define the differences in survival based on sex. Propensity score matching was used to adjust for differences between men and women. Results Of a total of 10 943 patients, 8650 (79.1%) were diagnosed with NSCLC, of whom 68.7% were men and 31.3% were women. For NSCLC, the median age was higher (69.0 vs. 67.0, p < 0.001) and the proportion of ever‐smokers (84.5% vs. 10.8%, p < 0.001) was higher in men. Adenocarcinoma (55.5% vs. 90.4%, p < 0.001) and stage I NSCLC (26.3% vs. 41.3%, p < 0.001) were more common in women. Survival was significantly lower in men with NSCLC (hazard ratio [HR] 1.493 [95% confidence interval, CI 1.238–1.800], p < 0.001) even after adjusting for meaningful clinical variables, and in the matched cohort (HR 1.339 [1.075–1.667], p = 0.009). Similarly, survival was significantly lower in men with stage IV adenocarcinoma after adjusting for other clinical variables (HR 1.493 [1.238–1.800], p < 0.001) and in the matched cohort (HR 1.339 [1.075–1.667]; p = 0.009). Conclusions Male patients with NSCLC had poorer prognosis, not only after variable adjustments for prognostic factors, but also in the matched cohort.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sex differences in the characteristics and survival of patients with non‐small‐cell lung cancer: A retrospective analytical study based on real‐world clinical data of the Korean population

Jeon

Kim

et al. 2022

Thoracic Cancer

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“…Moreover, the CLEAR Study has potential for selection bias due to the way cases and controls were recruited, and the data may be affected by survival bias as cases were recruited up to 18 months after diagnosis of lung cancer. Nevertheless, survival for never-smoking lung cancer cases is better than their smoking counterparts (Yu et al 2022 ), and > 50% of the cases were recruited within the first 6 months after diagnosis. Also, for the 20% of the participants linked to the population-based NSW Cancer Registry data, 96% were verified by the Registry [which is ‘gold standard’ for identifying incident cancer cases in a given geographical region (Goldsbury et al 2017 ; Kemp et al 2013 )], and the positive predictive value of self-reported lung cancer was 94.6% (Sitas et al 2015 ).…”

Section: Discussionmentioning

confidence: 99%

Evaluating risk factors for lung cancer among never-smoking individuals using two Australian studies

Cheng

Weber

Steinberg

et al. 2022

J Cancer Res Clin Oncol

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Purpose Lung cancer (LC) in never-smoking individuals would rank as Australia’s eighth most deadly cancer, yet risk factors remain uncertain. We investigated demographic, lifestyle and health-related exposures for LC among never-smoking Australians. Methods Using the prospective 45 and Up Study with 267,153 New South Wales (NSW) residents aged ≥ 45 years at recruitment (2006–2009), we quantified the relationship of 20 potential exposures with LC among cancer-free participants at baseline who self-reported never smoking. Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for incident LC were estimated using Cox regression. The NSW Cancer, Lifestyle and Evaluation of Risk (CLEAR) Study, a case–control study including 10,781 NSW residents aged ≥ 18 years (2006–2014), was used to examine 16 potential LC exposures among cancer-free never-smoking participants. Adjusted odds ratios (OR) and 95% CI of LC were estimated using logistic regression. Results There were 226 LC cases among 132,354 cancer-free 45 and Up Study participants who reported never smoking, with a median follow-up of 5.41 years. The CLEAR Study had 58 LC cases and 1316 cancer-free controls who had never smoked. Analyses of both datasets showed that Asian-born participants had a higher risk of LC than those born elsewhere: cohort, adjusted HR = 2.83 (95% CI 1.64–4.89) and case–control, adjusted OR = 3.78 (1.19–12.05). No significant association with LC was found for other exposures. Conclusion Our findings support the growing evidence that never-smoking, Asian-born individuals are at higher risk of developing LC than those born elsewhere. Ethnicity could be considered when assessing potential LC risk among never-smoking individuals.

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Risk as a pattern over time: Delineation of time‐dependent risk factors in biological, psychological, and social variables in cancer patients

Knefel

Lubowitzki

Krammer

et al. 2023

Cancer

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BackgroundSurvival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time.MethodsPatients who attended the authors’ outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model.ResultsThe median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0–4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short‐term, medium‐term, and long‐term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time‐independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long‐term.ConclusionsThe findings of this study allow the development of comprehensive patient‐specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care.

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Evaluating Prognostic Factors for Sex Differences in Lung Cancer Survival: Findings From a Large Australian Cohort

Cited by 30 publications

References 40 publications

Sex differences in the characteristics and survival of patients with non‐small‐cell lung cancer: A retrospective analytical study based on real‐world clinical data of the Korean population

Sex differences in the characteristics and survival of patients with non‐small‐cell lung cancer: A retrospective analytical study based on real‐world clinical data of the Korean population

Evaluating risk factors for lung cancer among never-smoking individuals using two Australian studies

Risk as a pattern over time: Delineation of time‐dependent risk factors in biological, psychological, and social variables in cancer patients

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