Resectable non-small cell lung cancer in women: A disease-specific entity?

There may be important sex-specific differences among patients with non-small cell lung cancer (NSCLC). Despite this, women are underrepresented in prospective clinical trials. We evaluated sex-specific differences in clinicopathologic and genetic factors and survival among patients with NSCLC.

This is a single-center study at a high-volume dedicated cancer hospital. Patients with NSCLC who underwent complete surgical resection from 2010 to 2018 were included. Primary outcomes include cumulative incidence of recurrence and overall survival, stratified by sex.

Overall, 3452 patients were included; 2033 (59%) were women. More women than men were never-smokers (24% vs 13%; P < .001). Among patients who smoked, women had a significantly shorter pack-year history (30 vs 40 years; P < .001). Comorbid pulmonary (29% vs 35%; P < .001) and cardiac (53% vs 66%; P < .001) conditions were less common among women. Women had lower rates of clinical stage II or III disease (P < .001) and were more likely to have EGFR (28% vs 18%; P < .001) or KRAS (36% vs 29%; P = .018) mutations. Median overall survival among women was 11 years (95% confidence interval [CI], 10 years to not reached), compared with 7.9 years among men (95% CI, 7.5-8.6). This longer survival was sustained on multivariable analysis (hazard ratio, 0.86; 95% CI, 0.76-0.97; P = .013). Cumulative incidence of recurrence was not statistically different by sex (hazard ratio, 0.95; 95% CI, 0.82-1.09; P = .43).

Clinicopathologic and genetic factors and survival among patients with NSCLC differ on the basis of sex. NSCLC in women should be considered a disease-specific entity.