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We thank Dr Goto1Goto T. Women fare better after lung-cancer surgery: What does this mean for clinical practice?.Chest. 2021; 159: 2119-2121Abstract Full Text Full Text PDF Scopus (1) Google Scholar for the interest in our recently published article.2Sachs E. Sartipy U. Jackson V. Sex and survival after surgery for lung cancer: s Swedish nationwide cohort.Chest. 2021; 159: 2029-2039Abstract Full Text Full Text PDF Scopus (5) Google Scholar In a nationwide population-based observational cohort study, we found that women who underwent pulmonary resections for lung cancer had significantly better prognosis than men. The survival difference was consistent across selected subgroups and independent of several important confounding factors.2Sachs E. Sartipy U. Jackson V. Sex and survival after surgery for lung cancer: s Swedish nationwide cohort.Chest. 2021; 159: 2029-2039Abstract Full Text Full Text PDF Scopus (5) Google Scholar Previous research has shown that male sex is associated with poorer survival in several forms of cancer.3Radkiewicz C. Johansson A.L.V. Dickman P.W. Lambe M. Edgren G. Sex differences in cancer risk and survival: a Swedish cohort study.Eur J Cancer. 2017; 84: 130-140Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar Another Swedish study showed that men with non-small cell lung cancer had a poorer prognosis, regardless of stage after careful adjustments for a wide range of prognostic factors.4Radkiewicz C. Dickman P.W. Johansson A.L.V. Wagenius G. Edgren G. Lambe M. Sex and survival in non-small cell lung cancer: a nationwide cohort study.PLoS One. 2019; 14e0219206Crossref PubMed Scopus (27) Google Scholar Our findings were thus in line with previous reports. Dr Goto raises the important question of smoking intensity as a possible explanation of the survival difference between men and women. Although we did account for smoking status (never, former, or current), preoperative FEV1.0, and COPD, we did not have detailed information regarding smoking intensity, and we acknowledged this limitation in the article. In answer to Dr Goto’s question regarding the number of patients who underwent pneumonectomy, there were 205 men (7.2%) and 164 women (4.5%) who had a pneumonectomy. As suggested by Dr Goto, this implies that tumors were more centrally located and that adequate surgical margins were more difficult to establish in men. We agree with Dr Goto that the clinical translation of our findings is as difficult as it is important. Should we modify diagnostics, treatment, or postoperative care according to sex? Because our study was not designed to provide definitive answers to these questions, further research in this area is needed. In particular, studies that would investigate possible sex-specific differences in relevant lifestyle factors and sociocultural conditions could provide valuable and actionable insights. Women Fare Better After Lung-Cancer Surgery: What Does This Mean for Clinical Practice?CHESTVol. 159Issue 5PreviewThe article by Sachs et al1 published in this issue of CHEST showed that women who underwent pulmonary resections for lung cancer had significantly better prognoses than men. I wish to discuss the implications of this finding. Full-Text PDF Sex and Survival After Surgery for Lung Cancer: A Swedish Nationwide CohortCHESTVol. 159Issue 5PreviewWomen who underwent pulmonary resections for lung cancer had a significantly better prognosis than men. The survival advantage was evident regardless of age, common comorbidities, socioeconomic status, lifestyle factors, physical performance, type and extent of surgery, tumor characteristics, and stage of disease. Full-Text PDF Open Access