Prognostic value of smoking status in operated non-small cell lung cancer
Prognostic value of smoking status in operated non-small cell lung cancer
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DOI：
10.1016/j.lungcan.2004.08.011
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发表时间：
2005-03-01
期刊：
影响因子：
5.3
通讯作者：
Van Schil, P
中科院分区：
文献类型：
--
作者：
Nia, PS;Weyler, J;Van Schil, P
尽管吸烟与肺癌风险增加之间存在着无可争议的联系，但将这一因素纳入预后生存分析中却很少。关于吸烟状态的重要临床问题是本研究的基础，如下：在发生肺癌之前不吸烟或戒烟的预后益处是什么，以及在诊断肺癌时戒烟的预后益处是什么？采用前瞻性问卷调查方法，对311例由同一外科医生施行手术的非小细胞肺癌（NSCLC）患者术前吸烟情况进行了调查。在分析的所有患者中，169例（54.3%）为当前吸烟者，25例（8.0%）为非吸烟者，82例（26.4%）为既往吸烟者，35例（11.3%）为近期戒烟者。采用考克斯多元回归模型检验吸烟状态与其他相关临床病理因素对生存的预后价值。对于总生存率，年龄较大（P = 0.011），存在淋巴结转移（P < 0.001）和目前吸烟（P = 0.001）为独立预测因子;预后不良，而非吸烟者（相对危险度= 0.447，95%置信区间0.206-0.970，P = 0.042），既往吸烟者（相对危险度= 0.543，95%可信区间= 0.350-0.843，P = 0.006）和近期戒烟者（相对危险度= 0.340，95%可信区间= 0.164-0.705，P = 0.064）与目前吸烟者（参照组）相比，预后明显更好。无病生存率也获得了类似的结果。这些结果表明，戒烟是有益的肺癌患者在肺手术前的任何时间点和当前吸烟在手术时与预后不良。(c)2004爱思唯尔爱尔兰有限公司保留所有权利。
Despite the indisputable link between smoking and the increased risk for lung cancer, the inclusion of this factor in prognostic survival analysis has been scarce. Important clinical questions regarding the smoking status are the basis of this study and are as follow: what is the prognostic benefit of having been a non-smoker or having stopped smoking prior to developing lung cancer and what is the prognostic benefit of smoking cessation at the time of diagnosis of lung cancer? Cigarette smoking status of 311 patients operated for non-small cell Lung cancer (NSCLC) by a single surgeon was determined based on two independent questionnaires taken prospectively prior to lung operation. Of all patients analysed, 169 (54.3%) were current smokers, 25 (8.0%) were non-smokers, 82 (26.4%) were former smokers and 35 (11.3%) were recent quitters. A Cox multiple regression model was used to test the prognostic value of smoking status on survival together with other relevant clinicopathological factors. For overall survival, older age (P = 0.011), presence of lymph node metastases (P < 0.001) and current smoking (P = 0.001) were independent predictors; of poor prognosis, while non-smokers (relative risk = 0.447, 95% confidence interval 0.206-0.970, P = 0.042), former smokers (relative risk = 0.543, 95% confidence interval = 0.350-0.843, P = 0.006) and recent quitters (relative risk = 0.340, 95% confidence interval = 0.164-0.705, P = 0.064) had a significant better prognosis compared to current smokers (referent group). Similar results were obtained for disease-free survival. These results indicate that smoking cessation is beneficial for lung cancer patients at any time point prior to lung operation and current smoking at the time of operation is associated with poor prognosis. (c) 2004 Elsevier Ireland Ltd. All rights reserved.