Impact of current versus former smoking status on the outcomes of non-metastatic non-small cell lung cancer treated with upfront surgery; findings from the National Lung Screening Trial

ABSTRACT

Objective: To evaluate the impact of current versus former smoking status on the outcomes of non-metastatic non-small cell lung cancer (NSCLC) treated with upfront surgery.

Methods: This is a post-hoc analysis of patients diagnosed with NSCLC, stage I-III within the National Lung Screening Trial (NLST). Kaplan-Meier analysis was used to delineate the impact of smoking status on overall survival. Moreover, Cox regression analyses were utilized to assess factors predicting overall and lung cancer-specific survival.

Results: A total of 773 patients were included in the current study. Former smokers (at the time of randomization of the NLST study) were 338 patients while current smokers were 435 patients. For overall survival, former smokers have better outcomes compared to current smokers (P = 0.023). Within multivariate Cox regression analysis, the following factors were predictive of worse overall survival: older age (P = 0.037), male gender (P = 0.022), current smoking (P = 0.022), advanced stage (P < 0.001) and preexisting stroke (P = 0.015). Likewise, the following factors were predictive of worse lung cancer-specific survival in multivariate Cox regression analysis: current smoking (P = 0.009) and advanced stage (P < 0.001).

Conclusions: Among patients with early-stage NSCLC treated with upfront surgery, current smokers have worse overall and lung cancer-specific survival compared to former smokers.

Expert opinion: Among patients with non-metastatic NSCLC treated with upfront surgical resection, current smokers have worse overall, lung cancer-specific and progression-free survival compared to former smokers. Smoking cessation counseling should be incorporated into management strategies of early stage NSCLC.

KEYWORDS:

• Lung cancer
• current smoking
• former smoking
• survival

Acknowledgments

The author(s) thank the National Cancer Institute for access to NCI’s data collected by the NLST. The statements contained herein are solely those of the author(s) and do not represent or imply concurrence or endorsement by NCI.

Declaration of interest

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers Disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approvals were obtained from respective IRBs of all participating centers in the four studies (as clarified in their clinicaltrials.gov records).

Informed consent

Informed consent was obtained from all participants included in the study.

Additional information

Funding

This paper was not funded.