{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:07:53Z","timestamp":1789708073721,"version":"4.0.1"},"reference-count":18,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Female sex is a well-established prognostic factor in non-small cell lung cancer (NSCLC). Most prior studies are restricted to single-treatment cohorts and seldom include best supportive care (BSC), limiting the evaluation of sex-based median overall survival across the full treatment spectrum, BSC included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective study of patients diagnosed with clinical stage I\u2013III NSCLC treated with curative intent (surgery, radiotherapy, or chemoradiation) or primary BSC. Survival rate was analyzed using log-rank tests and multivariable Cox regression to adjust for confounding prognostic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the total curative treatment cohort (n=1634), median overall survival (mOS) was 74.5 and 44.6 months in female and male patients, respectively [hazard ratio (HR) 0.60, P&amp;lt;0.001]. However, in the BSC cohort (n=234), mOS was similar between female (5.9 months) and male (5.8 months) patients (HR 0.93, P\u00a0=\u00a00.60). After stratification, mOS was not reached (females) versus 66.4 months (males) after surgery, (HR 0.58, P&amp;lt;0.001); 46.2 months (females) versus 33.0 months (males) after radiotherapy (HR 0.64, P&amp;lt;0.001); and 39.3 months (females) versus 26.9 months (males) after chemoradiation (HR 0.63, P&amp;lt;0.001). After multivariable adjustment, female survival benefit remained significant after curative-intent treatment overall (HR 0.72, P&amp;lt;0.001), surgery (HR 0.69, P\u00a0=\u00a00.003), and chemoradiation (HR 0.72, P\u00a0=\u00a00.02), but not after radiotherapy (HR 0.80, P\u00a0=\u00a00.12).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Female survival advantage in stage I\u2013III NSCLC is treatment-dependent and absent in the BSC cohort. Prospective studies with more detailed clinical, biological, and sociodemographic data are needed to determine whether sex independently affects survival or reflects other prognostic factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fonc.2026.1868017","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:33:48Z","timestamp":1789706028000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sex-based survival disparities in patients with stage I\u2013III non-small cell lung cancer vary by treatment modality"],"prefix":"10.3389","volume":"16","author":[{"given":"Guus R.M.","family":"van den Heuvel","sequence":"first","affiliation":[{"name":"Department of Pulmonology, Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas L.R.","family":"Mandos","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hans J.M.","family":"Smit","sequence":"additional","affiliation":[{"name":"Department of Pulmonology","place":["Rijnstate, Arnhem, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga C.J.","family":"Schuurbiers","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik H. J. G.","family":"Aarntzen","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, Radboud University Medical Center","place":["Nijmegen, Netherlands"]},{"name":"Department of Medical Imaging, Groningen University Medical Center","place":["Groningen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iris","family":"Walraven","sequence":"additional","affiliation":[{"name":"Department of Intelligent Quality (IQ) Health, Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Ciompi","sequence":"additional","affiliation":[{"name":"Department of Computational Pathology, Radboud University Medical Center","place":["Nijmegen, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel M.","family":"van den Heuvel","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, University Medical 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