Long-term Survival Outcomes by Smoking Status in Surgical and Nonsurgical Patients With Non-small Cell Lung Cancer Comparing Never Smokers and Current Smokers
Long-term Survival Outcomes by Smoking Status in Surgical and Nonsurgical Patients With Non-small Cell Lung Cancer Comparing Never Smokers and Current Smokers
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DOI：
10.1378/chest.08-2991
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发表时间：
2010-09-01
期刊：
影响因子：
9.6
通讯作者：
Brock, Malcolm V.
中科院分区：
文献类型：
--
作者：
Meguid, Robert A.;Hooker, Craig M.;Brock, Malcolm V.
背景：从不吸烟的非小细胞肺癌（NSCLC）手术后的生存结果特征不明确。这项研究比较了非小细胞肺癌患者的手术结果。方法：本研究是一项单机构回顾性研究，从1975年到2004年，非小细胞肺癌患者从不吸烟和现在吸烟。从4,546例非小细胞肺癌患者的分析队列中，我们确定了724例从不吸烟者和3,822例当前吸烟者。总的来说，1142名患者接受了手术治疗。对于吸烟状况的生存分析，使用Cox比例风险模型估计风险比（hr），然后通过其他变量进一步调整。结果：从不吸烟者女性（P < 0.01）、年龄较大（P < 0.01）、患腺癌（P < 0.01）和细支气管肺泡癌（P < 0.01）的可能性明显高于现吸烟者。分析队列（P = 0.35）和接受手术亚组（P = 0.24）的分期分布没有统计学上的显著差异。接受手术的非小细胞肺癌患者死亡的最大危险因素是晚期（校正风险比，3.43;95% CI, 2.32-5.07; P < 0.01）和美国麻醉医师学会分级升高（校正风险比，2.18;95% CI, 1.40-3.40; P < 0.01）。单因素分析显示，手术治疗组中吸烟者与从不吸烟者的死亡风险升高趋势较小（风险比，1.20;95% CI, 0.98-1.46; P = .07），当校正协变量（P = .97）时，完全消除了这一趋势。结论：我们的研究结果表明，肺癌诊断时吸烟状况对非小细胞肺癌患者的长期生存影响不大，尤其是在治愈性手术后。尽管不吸烟者和现在吸烟者的肺癌病因不同，但预后同样令人沮丧。胸部2010;138 (3): 500 - 509
Background: Survival outcomes of never smokers with non-small cell lung cancer (NSCLC) who undergo surgery are poorly characterized. This investigation compared surgical outcomes of never and current smokers with NSCLC.Methods: This investigation was a single-institution retrospective study of never and current smokers with NSCLC from 1975 to 2004. From an analytic cohort of 4,546 patients with NSCLC, we identified 724 never smokers and 3,822 current smokers. Overall, 1,142 patients underwent surgery with curative intent. For survival analysis by smoking status, hazard ratios (HRs) were estimated using Cox proportional hazard modeling and then further adjusted by other covatiates.Results: Never smokers were significantly more likely than current smokers to be women (P < .01), older (P < .01), and to have adenocarcinoma (P < .01) and bronchioloalveolar carcinoma (P < .01). No statistically significant differences existed in stage distribution at presentation for the analytic cohort (P = .35) or for the subgroup undergoing surgery (P = .24). The strongest risk factors of mortality among patients with NSCLC who underwent surgery were advanced stage (adjusted hazard ratio, 3.43; 95% CI, 2.32-5.07; P < .01) and elevated American Society of Anesthesiologists classification (adjusted hazard ratio, 2.18; 95% CI, 1.40-3.40; P < .01). The minor trend toward an elevated risk of death on univariate analysis for current vs never smokers in the surgically treated group (hazard ratio, 1.20; 95% CI, 0.98-1.46; P = .07) was completely eliminated when the model was adjusted for covariates (P = .97).Conclusions: Our findings suggest that smoking status at time of lung cancer diagnosis has little impact on the long-term survival of patients with NSCLC, especially after curative surgery. Despite different etiologies between lung cancer in never and current smokers the prognosis is equally dismal. CHEST 2010; 138(3):500-509