Abstract
OBJECTIVE: This study aims to investigate potential prognostic differences between male and female patients with non-small cell lung cancer under various antitumor treatment modalities, as well as to analyze potential factors influencing these differences. METHODS: This retrospective study included data from 715 non-small cell lung cancer patients who were diagnosed pathologically at our center between 2018 and 2024. The dataset comprised demographic characteristics, tumor features, and treatment-related information. Propensity score matching was employed to adjust for baseline imbalances between male and female groups. Prognostic differences based on gender were assessed using Kaplan-Meier survival analysis, log-rank tests, and multivariate Cox regression models, with additional subgroup analysis. RESULTS: Following propensity score matching, the median survival for male patients was 23 months, while female patients had a median survival of 29 months. The mortality risk for males was 29.2% higher compared to females (HR = 1.292, 95% CI 1.003-1.664, P = 0.044). In the EGFR-TKI subgroup, the mortality risk for males was 49% higher than for females (HR = 1.490, 95% CI 1.035-2.145, P = 0.028), whereas no significant gender-related differences were observed in the immune checkpoint inhibitor subgroup. Multivariate Cox regression analysis further confirmed that male patients faced a significantly increased mortality risk compared to females (HR = 1.31, 95% CI 1.01-1.70, P = 0.046). Furthermore, AJCC T stage, N stage, and M stage were identified as independent prognostic factors. Chemotherapy and anti-angiogenesis therapy were associated with a reduced mortality risk. Subgroup analysis revealed that male patients had significantly worse prognoses than female patients, particularly among those with early lymph node metastasis (N0-1), no distant metastasis (M0), no brain metastasis, and those who underwent surgery. CONCLUSION: Gender is an independent prognostic factor in NSCLC. Male patients generally experience shorter overall survival compared to female patients, particularly in those receiving EGFR-TKI therapy and in certain clinical stages. Gender should be considered in clinical practice when making treatment decisions. Future multicenter prospective studies are needed to further validate these findings and explore the underlying biological mechanisms.