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Difference in survival and prognostic factors between smokers and never-smokers with advanced non-small-cell lung cancer

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Abstract

Background

Our aims were to investigate whether the association between smoking and survival is significant when adjusted for prognostic factors including use of epidermal growth factor tyrosine kinase inhibitors and the Glasgow Prognostic Score, an established score for inflammation, and to explore prognostic factors.

Methods

We analyzed 244 patients with stage IIIB or IV non-small-cell lung cancer in a registry, including only chemotherapy-receiving outpatients with performance status zero.

Results

Of 244 patients, 170 had died and the median follow-up time for the 74 surviving patients was 12.0 months. In multivariate Cox regression, smoker (hazard ratio compared to never-smoker: 1.67, P < 0.01), stage IV (hazard ratio compared to IIIB: 1.72, P < 0.01), and elevated C-reactive protein level (hazard ratio per 1 mg/dL increase: 1.08, P < 0.01) were significantly associated with shorter survival. The association between survival and smoking was significant, even after adjustment for the Glasgow Prognostic Score and regimens of chemotherapy (hazard ratio: 1.72, P = 0.02). In never-smokers, increased neutrophils were a major determinant of shorter survival and the interaction test between smoking and neutrophils was significant (hazard ratio per 1,000/mm3 increase for smokers: 1.01; hazard ratio per 1,000/mm3 increase for never-smokers: 1.44, P for interaction <0.01).

Conclusions

Known factors including treatment response or inflammatory process are not responsible for the fact that advanced non-small-cell lung cancer patients without any history of smoking have better survival than those who have smoked.

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Conflict of interest

K. Yanagihara received research funding from Taiho Pharmaceutical and Chugai Pharmaceutical. The other authors declare no conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Shiro Tanaka, Satoshi Teramukai & Masanori Fukushima

  2. Outpatient Oncology Unit, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Kazuhiro Yanagihara, Toshiyuki Kitano & Masanori Fukushima

  3. Department of Translational Clinical Oncology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Kazuhiro Yanagihara & Toshiyuki Kitano

  4. Institute of Human Research Promotion and Drug Development, Mie University Faculty of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507, Japan

    Satoshi Tamaru

  5. Department of Clinical Innovative Medicine, Translational Research Center, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Satoshi Tamaru

  6. Translational Research Informatics Center, 1-5-4 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan

    Masanori Fukushima

Authors
  1. Shiro Tanaka
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  2. Kazuhiro Yanagihara
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  3. Satoshi Tamaru
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  4. Satoshi Teramukai
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  5. Toshiyuki Kitano
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  6. Masanori Fukushima
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Corresponding author

Correspondence to Shiro Tanaka.

Additional information

S. Tanaka, K. Yanagihara and S. Tamaru contributed equally to this work.

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Tanaka, S., Yanagihara, K., Tamaru, S. et al. Difference in survival and prognostic factors between smokers and never-smokers with advanced non-small-cell lung cancer. Int J Clin Oncol 18, 17–25 (2013). https://doi.org/10.1007/s10147-011-0334-z

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  • DOI: https://doi.org/10.1007/s10147-011-0334-z

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