0
Original Research: CANCER |

Long-term Survival Outcomes by Smoking Status in Surgical and Nonsurgical Patients With Non-small Cell Lung Cancer: Comparing Never Smokers and Current Smokers

Robert A. Meguid, MD; Craig M. Hooker, MPH; James Harris, MD; Li Xu, MS; William H. Westra, MD; J. Timothy Sherwood, MD; Marc Sussman, MD; Stephen M. Cattaneo, II, MD; James Shin, BS; Solange Cox, BA; Joani Christensen, BA; Yelena Prints, BS; Nance Yuan, BA; Jennifer Zhang, BS; Stephen C. Yang, MD; Malcolm V. Brock, MD
Author and Funding Information

From the Division of Thoracic Surgery (Drs Meguid, Harris, Sussman, Cattaneo, Yang, and Brock and Mss Cox, Christensen, Prints, Yuan, and Zhang), Department of Surgery; Department of Oncology (Drs Yang and Brock, Mssr Hooker and Shin, and Ms Xu), Johns Hopkins School of Medicine; and Department of Pathology (Dr Westra), Johns Hopkins School of Medicine, Baltimore, MD; and Virginia Cardiovascular and Thoracic Surgery Group (Dr Sherwood), Mary Washington Hospital, Fredericksburg, VA.

Correspondence to: Malcolm V. Brock, MD, Division of Thoracic Surgery, Department of Surgery, 600 N Wolfe St, Blalock 240, The Johns Hopkins Hospital, Baltimore, MD 21287; e-mail: mbrock1@jhmi.edu


Funding/Support: Dr Meguid is supported by the Ruth L. Kirschstein National Research Service Award (T32DK007713). Dr Brock is supported by a National Institutes of Health/National Cancer Institute Specialized Programs of Research Excellence Grant in Lung Cancer (CA058184-14) and by the Commonwealth Foundation for Cancer Research. Mr Hooker is supported by the James Ryan Fund at The Johns Hopkins University.

Dr Meguid and Mr Hooker contributed equally to this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(3):500-509. doi:10.1378/chest.08-2991
Text Size: A A A
Published online

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 covariates.

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.


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Detection of Loss of Heterozygosity by High-Resolution Fluorescent System in Non-small Cell Lung Cancer*: Association of Loss of Heterozygosity With Smoking and Tumor Progression
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543