Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea;
Division of Hematology-Oncology, Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea;
J Thorac Dis. 2013 Dec;5(6):758-63. doi: 10.3978/j.issn.2072-1439.2013.11.24.
This study was conducted to evaluate whether or not tumor spread and the diagnostic process in non-small cell lung cancer (NSCLC) is different based on smoking history.
Associations between smoking status and clinical presentation were evaluated controlling for the effect of histology. Lung cancer with delayed diagnosis (LCDD) and incidental detection (LCID) were determined based on medical records.
Of 914 patients, frequency of distant metastases was more common in never-smokers than in smokers (59% and 36%, respectively; P<0.001). Although never-smokers were more likely to have LCDD than smokers (18% and 11%, respectively; P=0.038), LCDD were not significantly associated with frequency of distant metastases [49% (LCDD) vs. 42% (non-LCDD); P=0.189] as well as tumor [29% (T3-4) vs. 24% (T1-2); P=0.134] and node [43% (N2-3) vs. 44% (N0-1); P=0.838] stage. Interestingly, never-smokers are more likely to have LCID than smokers (31% and 19%, respectively; P=0.010). In survival analysis, LCID (P=0.001; HR, 0.63) remained a prognostic factor, while LCDD did not.
This study suggests distinct metastatic pattern and diagnostic processes of never-smokers. The link between survival and incidental detection was also indicated.
本研究旨在评估非小细胞肺癌（NSCLC）的肿瘤转移和诊断过程是否因吸烟史而不同。
通过控制组织学的影响，评估吸烟状况与临床表现之间的关联。根据病历确定肺癌延迟诊断（LCDD）和偶然发现（LCID）。
在 914 名患者中，从不吸烟者远处转移的频率高于吸烟者（分别为 59%和 36%；P<0.001）。尽管从不吸烟者比吸烟者更有可能出现 LCDD（分别为 18%和 11%；P=0.038），但 LCDD 与远处转移的频率（49%（LCDD）与 42%（非-LCDD）；P=0.189）以及肿瘤（29%（T3-4）与 24%（T1-2）；P=0.134）和淋巴结（43%（N2-3）与 44%（N0-1）；P=0.838）分期均无显著相关性。有趣的是，从不吸烟者比吸烟者更有可能出现 LCID（分别为 31%和 19%；P=0.010）。在生存分析中，LCID（P=0.001；HR，0.63）仍然是一个预后因素，而 LCDD 则不是。
本研究表明，从不吸烟者具有独特的转移模式和诊断过程。生存与偶然发现之间的联系也得到了证实。
