Impact of sex on prognostic host factors in surgical patients with lung cancer

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Despite significant advances in oncology translational research, survival rates of patients with lung cancer are suboptimal. Fifty percent of patients with stage I disease will have disease recurrence within 5 years.1 Improved outcomes for patients with non‐small cell lung cancer (NSCLC) will depend on the development of more accurate outcome prediction models to facilitate better selection of patient for treatment and optimal clinical trial design. The current tool, the International Union for Cancer Control (UICC), American Joint Committee on Cancer (AJCC) and International Association for the Study of Lung Cancer's (IASLC) tumour, node and metastasis (TNM) staging system,2 demonstrates significant heterogeneity in outcomes for patients with NSCLC as demonstrated by the high recurrence rate for patients with stage I disease.1
The IASLC and UICC have defined prognostic factors in NSCLC as ‘tumour, host or environmental factors’.3 The TNM staging system is an anatomical tumour‐based staging system with powerful prognostic value but does not include host factors. Lung cancer survival, with the highest global mortality rate of any cancer,4 is strongly influenced by the host factor sex, with markedly poorer outcomes in men. The American Surveillance, Epidemiology and End Results (SEER) database documents a mortality rate ratio for men : women of 1.82, and a hazard ratio (HR) of 1.17 for men after controlling for age and stage.5
As defined in the IASLC/UICC staging manual, important host prognostic factors include the age, performance status at diagnosis and smoking history.2 This study aimed to determine whether sex was a significant and an independent predictor of disease‐specific survival, after accounting for other known prognostic factors, in a surgical patient cohort from the Peter MacCallum Cancer Centre and St Vincent's Hospital (Melbourne cohort) and compare this to patterns observed in the SEER cohort. It then sought to determine the prognostic value of host factors within sex groups in the Melbourne cohort after accounting for disease‐related prognostic factors.

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