Sex differences in inoperable lung cancer risk and prognosis: Evidence from low-income population setting

Recent decades have seen a dramatic shift in the demographics of lung cancer. Despite a decrease in overall lung cancer incidence relative to men, women now appear at greater risk of developing the disease, suggesting distinct risk profiles and disease processes between men and women. The study aimed to explore the sex-based differences in lung cancer risk and prognosis in low-resource settings. We included 1868 (1580 men, 288 women) newly diagnosed and histologically confirmed primary lung cancer patients admitted to the National Institute of Cancer Research and Hospital (NICRH), Bangladesh in 2018 and 2019. Patients were follow-up until June 30, 2020, or the event of death, whichever came first. Sex differences in risk factor profile and survival were assessed using Cox proportional hazard models. On average, women (55.3 ± 12.9) were younger than men (60.4 ±10.3), More men were smokers (P = 0.001), more women used smokeless tobacco (P = 0.35), and at diagnosis had more comorbidities (p < 0.001). Adenocarcinoma (46.3%) was the predominant histological type in women, and squamous cell carcinoma (43.2%) was in men. In Men age ≥60 years, <18.5 Kg/m2, with No-formal schooling and having comorbidity, and in women, Tobacco use appeared as a predictor of poor survival. Irrespective of performance status and treatment—women with adenocarcinoma [HR-0.64 (95% CI; 0.44–0.91)] tend to survive longer than men. The trend is reversed in squamous cell carcinoma [HR-1.31 (95%CI; 1.04–1.63)].Women who received no treatment (HR; 0.65, 95%CI; 0.44–0.96) or received CT only (HR; 0.54, 95%CI; 0.34–0.85) were less likely to die in comparison to their men counterparts, after adjusting for age, education, smoking habit, performance status, and comorbidity. Women lung cancer patients are a distinct subgroup and have differences from their male counterparts in terms of risk factors, histological types, and prognosis. The risk factors, histopathology, and prognosis associated with inoperable lung cancer differ based on the gender and further research is needed in this area.