Prediagnosis Smoking Cessation and Overall Survival Among Patients With Non-Small Cell Lung Cancer.
Prediagnosis Smoking Cessation and Overall Survival Among Patients With Non-Small Cell Lung Cancer.
复制标题
非小细胞肺癌患者的诊断前戒烟和总体生存率。
DOI：
10.1001/jamanetworkopen.2023.11966
复制
发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
Christiani, David C.
中科院分区：
文献类型：
--
作者：
Wang, Xinan;Romero-Gutierrez, Christopher W.;Kothari, Jui;Shafer, Andrea;Li, Yi;Christiani, David C.
Is prediagnosis smoking cessation associated with overall survival among patients with non–small cell lung cancer? In this long-term follow-up cohort study of lung cancer survivors, compared with never smokers, former and current smokers had 26% and 68% higher mortality, respectively, and log2-transformed year since smoking cessation before diagnosis was associated with significantly lower mortality among ever smokers. These findings suggest that quitting smoking early is associated with lower mortality following a lung cancer diagnosis, and the association of smoking history with overall survival may vary depending on clinical stage at diagnosis, potentially because of the differing treatment regimens and efficacy associated with smoking exposure following diagnosis. This cohort study examines the association of years since smoking cessation before diagnosis and cumulative smoking pack-years with overall survival in patients with non–small cell lung cancer. Lung cancer remains the leading cause of cancer-related death globally; non–small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases, and cigarette smoking is the factor most significantly associated with its risk. However, little is known about the association of years since prediagnosis smoking cessation and cumulative smoking with overall survival (OS) following a lung cancer diagnosis. To characterize the association of years since smoking cessation before diagnosis and cumulative smoking pack-years with OS in patients with NSCLC in a lung cancer survivor cohort. The cohort study involved patients with NSCLC who were recruited to the Boston Lung Cancer Survival Cohort at Massachusetts General Hospital (Boston, Massachusetts) between 1992 and 2022. Patients’ smoking history and baseline clinicopathological characteristics were prospectively collected through questionnaires, and OS following lung cancer diagnosis was regularly updated. Duration of smoking cessation before a lung cancer diagnosis. The primary outcome was the association of detailed smoking history with OS following a lung cancer diagnosis. Of 5594 patients with NSCLC (mean [SD] age, 65.6 [10.8] years; 2987 men [53.4%]), 795 (14.2%) were never smokers, 3308 (59.1%) were former smokers, and 1491 (26.7%) were current smokers. Cox regression analysis suggested that former smokers had 26% higher mortality (hazard ratio [HR], 1.26; 95% CI, 1.13-1.40; P < .001) and current smokers had 68% higher mortality (HR, 1.68; 95% CI, 1.50-1.89; P < .001) compared with never smokers. Log2-transformed years since smoking cessation before diagnosis were associated with significantly lower mortality among ever smokers (HR, 0.96; 95% CI, 0.93-0.99; P = .003). Subgroup analysis, stratified by clinical stage at diagnosis, revealed that former and current smokers had even shorter OS among patients with early-stage disease. In this cohort study of patients with NSCLC, quitting smoking early was associated with lower mortality following a lung cancer diagnosis, and the association of smoking history with OS may have varied depending on clinical stage at diagnosis, potentially owing to the differing treatment regimens and efficacy associated with smoking exposure following diagnosis. Detailed smoking history collection should be incorporated into future epidemiological and clinical studies to improve lung cancer prognosis and treatment selection.
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39.2
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Sheikh, Mahdi;Mukeriya, Anush;Zaridze, David
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Jemal, Ahmedin