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Long-term Outcomes After Lung Cancer Resection in Smokers: Analysis of the National Lung Screening Trial

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Abstract

Background

Smoking is a known risk factor for perioperative complications after lung resection; however, little data exists looking at the impact of smoking status (current versus former) on long-term oncologic outcomes after lung cancer surgery. We sought to compare overall survival (OS), progression-free survival (PFS), and cancer-specific mortality (CSM) in current and former smokers using data from the National Lung Screening Trial (NLST). Additionally, we performed subset analysis in current smokers in order to evaluate the effect of modern surgical techniques on long-term outcomes.

Methods

Patients with clinical stage IA or IB NSCLC who underwent upfront resection within 180 days of diagnosis were identified in the NLST database. Cox proportional hazard regression models were used to assess differences in patient and treatment characteristics with respect to OS and PFS, with a cause-specific hazard model used for CSM.

Results

A total of 593 patients were included in the study (269 former smokers, 324 current smokers). Lobar resection (LR) was performed more often than sublobar resection (SLR) (481 vs. 112), and thoracotomy was performed more often than thoracoscopy (482 vs. 86). Comparison of current versus former smokers showed no difference in OS or PFS after resection. Higher CSM was seen in current smokers (p = 0.049). Subset analysis of current smokers revealed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Although higher CSM was associated with thoracoscopy versus thoracotomy in this group, this finding was limited by a relatively small thoracoscopy sample size of 44 patients (p = 0.026).

Conclusion

Our analysis of the NLST database shows no significant difference in OS and PFS when comparing current and former smokers undergoing resection for stage I NSCLC. Active smoking status was associated with higher CSM. Subset analysis of current smokers showed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Higher CSM was seen in current smokers who underwent thoracoscopy compared to thoracotomy; however, this finding was limited by a small sample size.

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Abbreviations

BMI:

Body mass index

CSM:

Cancer specific mortality

HR:

Hazards ratio

OS:

Overall survival

PFS:

Progression free survival

LR:

Lobar resection

NLST:

National lung screening trial

NSCLC:

Non-small cell lung cancer

SLR:

Sublobar resection

VATS:

Video-assisted thoracoscopic surgery

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA

    Joanna Sesti, Jaimie Bell, Andrew Nguyen, Adam Lackey & Subroto Paul

  2. Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ, 07112, USA

    Jonathan Decker

  3. Department of Surgery, RWJBarnabas Health, 94 Old Short Hills Road, Livingston, NJ, 07039, USA

    Amber L. Turner

  4. Department of Biostatistics, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA

    Patrick Hilden

Authors
  1. Joanna Sesti
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  2. Jonathan Decker
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  3. Jaimie Bell
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  4. Andrew Nguyen
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  5. Adam Lackey
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  8. Subroto Paul
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Corresponding author

Correspondence to Joanna Sesti.

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There are no conflicts of interest reported by any author.

Ethical approval

This study was approved by our institutional review board, IRB protocol No. 17–67.

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Appendix

Appendix

See Table 4.

Table 4 Codes Used for cohort identification and procedure types
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Sesti, J., Decker, J., Bell, J. et al. Long-term Outcomes After Lung Cancer Resection in Smokers: Analysis of the National Lung Screening Trial. World J Surg 46, 265–271 (2022). https://doi.org/10.1007/s00268-021-06311-0

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  • DOI: https://doi.org/10.1007/s00268-021-06311-0

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