Abstract
Objective
The aim of this study was to investigate the smoking status of lung cancer patients and to confirm the risk of smoking for patients undergoing lung cancer surgery.
Methods
We conducted a retrospective study of patients undergoing lung cancer surgery. Between May 2004 and March 2013, 716 patients underwent lung cancer surgery at our institution. Based on smoking status, the patients were classified into 3 groups: nonsmoker, past smoker, and current smoker. Based on exclusion criteria, a final total of 670 patients were investigated for the association between smoking status and postoperative complications. In addition, we explored the effect of smoking on survival after surgery.
Results
There were 254 non-smokers, 246 past smokers, and 170 current smokers. The percent of female patients, adenocarcinoma, and stage IA cancer was highest in the nonsmokers. Respiratory function was significantly impaired in past and current smokers. Respiratory and cardiac complications were found less frequently in non-smokers (11.4 %) followed by 17.1 % of past smokers and 21.2 % of current smokers (p = 0.0226). Univariate analysis showed that smoking was a significantly poor prognostic factor for overall survival. The 5-year survival rates for non-smokers, past, and current smokers were 81.4, 65.4, and 68.8 %, respectively (p = 0.0003).
Conclusions
Smokers with lung cancer tended to have advanced lung cancer, impaired pulmonary function, and high morbidity after lung cancer surgery. Although multivariate analysis did not show that smoking was associated with poor outcome, non-smokers had significantly better overall survival, even for patients with stage IA lung cancers.
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References
Amano J, Kuwano H, Yokomise H. Thoracic and cardiovascular surgery in Japan during 2011. Gen Thorac Cardiovasc Surg. 2013;61:578–607.
Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin. 2011;61:69–90.
Ministry of Health, Labour and Welfare home page. http://www.mhlw.go.jp/bunya/kenkou/eiyou/h24-houkoku.html. Accessed 24 May 2014.
Ogawa F, Wang G, Matsui Y, Hara H, Iyoda A, Satoh Y. Risk factors of postoperative complications in the elderly with lung cancer. Asian Cardiovasc Thorac Ann. 2013;21:313–8.
Fujisawa T, Iizasa T, Saitoh Y, Sekine Y, Motohashi S, Yasukawa T, et al. Smoking before surgery predicts poor long-term survival in patients with stage I non-small cell lung carcinomas. J Clin Oncol. 1999;17:2086–91.
Nordquist LT, Simon GR, Cantor A, Alberts WM, Bepler G. Improved survival in never-smokers vs current smokers with primary adenocarcinoma of the lung. Chest. 2004;126:347–51.
Yoshino I, Kawano D, Oba T, Yamazaki K, Kemetani T, Maehara Y. Smoking status as a prognostic factor in patients with stage I pulmonary adenocarcinoma. Ann Thorac Surg. 2006;81:1189–93.
Bryant A, Cerfolio RJ. Differences in epidemiology, histology, and survival between cigarette smokers and never-smokers who develop non-small cell lung cancer. Chest. 2007;132:185–92.
Maeda R, Yoshida J, Ishii G, Hishida T, Nishimura M, Nagai K. The prognostic impact of cigarette smoking on patients with non-small cell lung cancer. J Thorac Oncol. 2011;6:735–42.
Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. International Association for the Study of Lung Cancer International Staging Committee; Participating Institutions. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007;2:706–14.
Shiono S, Yoshida J, Nishimura M, Hagiwara M, Hishida T, Nitadori J, et al. Risk factors of postoperative respiratory infections in lung cancer surgery. J Thorac Oncol. 2007;2:34–8.
Taylor MD, LaPar DJ, Isbell JM, Kozower BD, Lau CL, Jones DR. Marginal pulmonary function should not preclude lobectomy in selected patients with non-small cell lung cancer. J Thorac Cardiovasc Surg. 2014;147:738–46.
Kawaguchi T, Takeda M, Kubo A, Matsumura A, Fukai S, Tamura A, et al. Performance status and smoking status are independent favorable prognostic factors for survival in non-small cell lung cancer. J Thorac Oncol. 2010;5:620–30.
Tammemagi CM, Neslund-Dudas C, Simoff M, Kvale P. Smoking and lung cancer survival. Role of comorbidity and treatment. Chest. 2004;125:27–37.
Park SY, Lee JG, Bae MK, Lee CY, Kim DJ, Chung KY. The influence of smoking intensity on the clinicopathological features and survival of patients with surgically treated non-small cell lung cancer. Lung Cancer. 2013;81:480–6.
National Comprehensive Cancer Network. Guidelines for surveillance following therapy for non-small cell lung cancer Ver 2.2013. http://www.nccn.com. Accessed 16 May 2013.
Colt HG, Murgu SD, Korst RJ, Slatore CG, Unger M, Quadrelli S. Follow-up and surveillance of the patient with lung cancer after curative-intent therapy: diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2013;143S:e437S–54S.
Cooley ME, Sarna L, Kotlerman J, et al. Smoking cessation is challenging even for patients recovering from lung cancer surgery with curative intent. Lung Cancer. 2009;66:218–25.
Eng L, Su J, Qiu X, Palepu PR, Hon H, Fadhel E, et al. Second-hand smoke as a predictor of smoking cessation among lung cancer survivors. J Clin Oncol. 2014;32:564–70.
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We did not receive any funding or financial support for this study.
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Shiono, S., Katahira, M., Abiko, M. et al. Smoking is a perioperative risk factor and prognostic factor for lung cancer surgery. Gen Thorac Cardiovasc Surg 63, 93–98 (2015). https://doi.org/10.1007/s11748-014-0461-3
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DOI: https://doi.org/10.1007/s11748-014-0461-3