Division of Thoracic Surgery, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Chest. 2010 Sep;138(3):500-9. doi: 10.1378/chest.08-2991. Epub 2010 May 27.
Survival outcomes of never smokers with non-small cell lung cancer (NSCLC) who undergo surgery are poorly characterized. This investigation compared surgical outcomes of never and current smokers with NSCLC.
This investigation was a single-institution retrospective study of never and current smokers with NSCLC from 1975 to 2004. From an analytic cohort of 4,546 patients with NSCLC, we identified 724 never smokers and 3,822 current smokers. Overall, 1,142 patients underwent surgery with curative intent. For survival analysis by smoking status, hazard ratios (HRs) were estimated using Cox proportional hazard modeling and then further adjusted by other covariates.
Never smokers were significantly more likely than current smokers to be women (P < .01), older (P < .01), and to have adenocarcinoma (P < .01) and bronchioloalveolar carcinoma (P < .01). No statistically significant differences existed in stage distribution at presentation for the analytic cohort (P = .35) or for the subgroup undergoing surgery (P = .24). The strongest risk factors of mortality among patients with NSCLC who underwent surgery were advanced stage (adjusted hazard ratio, 3.43; 95% CI, 2.32-5.07; P < .01) and elevated American Society of Anesthesiologists classification (adjusted hazard ratio, 2.18; 95% CI, 1.40-3.40; P < .01). The minor trend toward an elevated risk of death on univariate analysis for current vs never smokers in the surgically treated group (hazard ratio, 1.20; 95% CI, 0.98-1.46; P = .07) was completely eliminated when the model was adjusted for covariates (P = .97).
Our findings suggest that smoking status at time of lung cancer diagnosis has little impact on the long-term survival of patients with NSCLC, especially after curative surgery. Despite different etiologies between lung cancer in never and current smokers the prognosis is equally dismal.
从未吸烟的非小细胞肺癌 (NSCLC) 患者的手术生存结果特征不佳。本研究比较了从未吸烟和当前吸烟的 NSCLC 患者的手术结果。
本研究是一项对 1975 年至 2004 年从未吸烟和当前吸烟的 NSCLC 患者的单机构回顾性研究。从 NSCLC 的分析队列 4546 例患者中，我们确定了 724 名从未吸烟者和 3822 名当前吸烟者。共有 1142 例患者接受了根治性手术。为了按吸烟状况进行生存分析，使用 Cox 比例风险模型估计风险比 (HR)，然后进一步通过其他协变量进行调整。
从未吸烟者明显比当前吸烟者更有可能是女性 (P <.01)、年龄更大 (P <.01)、腺癌 (P <.01) 和细支气管肺泡癌 (P <.01)。分析队列的分期分布 (P =.35) 或接受手术的亚组 (P =.24) 没有统计学上的显著差异。接受手术的 NSCLC 患者死亡的最强危险因素是晚期 (调整后的危险比，3.43；95%CI，2.32-5.07；P <.01) 和美国麻醉师协会分类升高 (调整后的危险比，2.18；95%CI，1.40-3.40；P <.01)。在手术治疗组中，当前吸烟者与从未吸烟者相比，死亡风险在单因素分析中略有增加 (危险比，1.20；95%CI，0.98-1.46；P =.07)，但当模型调整协变量时，这一差异完全消除 (P =.97)。
我们的发现表明，肺癌诊断时的吸烟状况对 NSCLC 患者的长期生存影响不大，尤其是在根治性手术后。尽管从未吸烟和当前吸烟的肺癌患者的病因不同，但预后同样不佳。
