Prognostic Impact of Smoking Period in Patients with Surgically Resected Non-small Cell Lung Cancer
Prognostic Impact of Smoking Period in Patients with Surgically Resected Non-small Cell Lung Cancer
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DOI：
10.1245/s10434-020-08851-6
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发表时间：
2020-07-16
影响因子：
3.7
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
--
作者：
Takamori, Shinkichi;Shimokawa, Mototsugu;Mori, Masaki
背景
吸烟包年指数通过吸烟时长乘以每日吸烟包数来计算，常被用于研究患肺癌的风险。然而，值得注意的是，在接受根治性肺切除的非小细胞肺癌（NSCLC）患者中，吸烟时长和每日吸烟包数哪个对术后预后更具预测性仍不清楚。
患者与方法
初步筛选包括2005名在2000年至2016年间于日本一家中心接受根治性肺切除的连续肺癌患者。最终对1134名有吸烟史的NSCLC患者的数据进行了分析。采用时间依赖性曲线下面积（AUCs）来比较诊断准确性。
结果
单变量分析显示，每日吸烟包数不是无病生存期（DFS；p = 0.2387）或总生存期（OS；p = 0.1357）的显著预测因素。多变量分析显示，吸烟时长是DFS和OS的独立预测因素（两者p < 0.0001）。时间依赖性吸烟时长的AUCs优于每日吸烟包数的AUCs。在亚组分析中，吸烟时长≥40年的患者的DFS和OS显著短于吸烟时长<40年的患者，且与性别、临床分期和组织学类型无关。
结论
吸烟时长是接受根治性肺切除的NSCLC患者的一个重要预后指标，应在进一步的大样本前瞻性和/或多中心研究中进行验证。
Background The pack-year index, which is calculated by multiplying a smoking period by the number of cigarette packs smoked per day, is frequently used to investigate the risk of developing lung cancer. Notably, however, whether the smoking period or the number of packs per day is more predictive of postoperative prognosis remains unclear in non-small cell lung cancer (NSCLC) patients who receive curative lung resection. Patients and Methods Initial screening included 2055 consecutive lung cancer patients who had underwent curative lung resection between 2000 and 2016 at a single center in Japan. Data from 1134 NSCLC patients with smoking history were ultimately analyzed. Time-dependent areas under the curve (AUCs) were used to compare diagnostic accuracy. Results On univariate analysis, the number of packs smoked per day was not a significant predictor of disease-free survival (DFS;p = 0.2387) or overall survival (OS;p = 0.1357). On multivariable analysis, smoking period was an independent predictor of DFS and OS (bothp < 0.0001). Time-dependent smoking period AUCs were superior to those of number of packs smoked per day. On subgroup analyses, patients with a smoking period >= 40 years had significantly shorter DFS and OS than those with a smoking period of < 40 years, independent of sex, clinical stage, and histological type. Conclusions Smoking period was a significant prognostic indicator in NSCLC patients who underwent curative lung resection, which should be validated in further prospective and/or multicenter studies with large sample sizes.