Effect of smoking on survival from non-small cell lung cancer: a retrospective Veterans’ Affairs Central Cancer Registry (VACCR) cohort analysis
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Although a well-established risk factor for lung cancer, the impact of smoking on the survival of non-small cell lung cancer (NSCLC) is not well known. We performed a retrospective analysis of the Veteran’s Affairs Comprehensive Cancer Registry of NSCLC patients. Smoking status was categorized as never smoker, past smoker and current smoker based on self-reported history. Multivariate analysis was performed to evaluate the impact of smoking on overall survival (OS) from NSCLC. The study population (n = 61,440) comprised predominantly of males (98 %) and Caucasians (81 %). The median age at diagnosis was 68 years (range 22–108 years). Current smokers were diagnosed with NSCLC at a younger age (65 years) compared to never smokers (71 years) and past smokers (72 years) (p < 0.001). On multivariate analysis, current smokers (n = 34,613) [Hazard ratio (HR) 1.059; 95 % confidence interval (CI) 1.012–1.108], but not past smokers (n = 23,864) (HR 1.008; 95 % CI 0.962–1.056), had worse OS for Stage III and IV NSCLC, compared to never smokers (n = 2,963). Smoking status was not prognostic in stages I and II NSCLC. Current smokers were diagnosed with NSCLC at a younger age than never smokers. Although current smoking was associated with worse prognosis, especially in stages III and IV, the impact of smoking status on OS was modest.
KeywordsNon-small cell lung cancer Tobacco Smoking Outcomes Survival
The facilities of the VA-Nebraska Western Iowa Health Care System were used during the course of this study.
Conflict of interest
There are no conflicts of interest associated with the contents of this manuscript.
- 4.Haga Y, Hiroshima K, Iyoda A, Shibuya K, Shimamura F, Iizasa T, Fujisawa T, Ohwada H. Ki-67 expression and prognosis for smokers with resected stage I non-small cell lung cancer. Ann Thorac Surg. 2003;75:1727–32; discussion 32-3.Google Scholar
- 16.Kawaguchi T, Takada M, Kubo A, Matsumura A, Fukai S, Tamura A, Saito R, Maruyama Y, Kawahara M, Ignatius Ou. SH. Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer: a comprehensive analysis of 26,957 patients with NSCLC. J Thorac Oncol. 2010;5:620–30.PubMedGoogle Scholar
- 27.Kogure Y, Ando M, Saka H, Chiba Y, Yamamoto N, Asami K, Hirashima T, Seto T, Nagase S, Otsuka K, Yanagihara K, Takeda K, et al. Histology and smoking status predict survival of patients with advanced non-small-cell lung cancer: results of West Japan Oncology Group (WJOG) Study 3906L. J Thorac Oncol. 2013;8:753–8.PubMedCrossRefGoogle Scholar
- 41.Stellman SD, Takezaki T, Wang L, Chen Y, Citron ML, Djordjevic MV, Harlap S, Muscat JE, Neugut AI, Wynder EL, Ogawa H, Tajima K, et al. Smoking and lung cancer risk in American and Japanese men: an international case-control study. Cancer Epidemiol Biomarkers Prev. 2001;10:1193–9.PubMedGoogle Scholar
- 42.Rosenberger A, Illig T, Korb K, Klopp N, Zietemann V, Wolke G, Meese E, Sybrecht G, Kronenberg F, Cebulla M, Degen M, Drings P, et al. Do genetic factors protect for early onset lung cancer? A case control study before the age of 50 years. BMC Cancer. 2008;8:60.PubMedCentralPubMedCrossRefGoogle Scholar
- 44.Kawaguchi T, Matsumura A, Fukai S, Tamura A, Saito R, Zell JA, Maruyama Y, Ziogas A, Kawahara M, Ignatius Ou SH. Japanese ethnicity compared with Caucasian ethnicity and never-smoking status are independent favorable prognostic factors for overall survival in non-small cell lung cancer: a collaborative epidemiologic study of the National Hospital Organization Study Group for Lung Cancer (NHSGLC) in Japan and a Southern California Regional Cancer Registry databases. J Thorac Oncol. 2010;5:1001–10.PubMedGoogle Scholar