非小细胞肺癌中从不吸烟者与曾经吸烟者之间的临床病理及生存差异。

The clinicopathological and survival differences between never and ever smokers with non-small cell lung cancer.

作者信息

Muallaoglu Sadik, Karadeniz Cemile, Mertsoylu Huseyin, Ayberk Besen Ali, Sezer Ahmet, Murat Sedef Ali, Kose Fatih, Ozyilkan Ozgur

机构信息

Baskent University, School of Medicine, Department of Medical Oncology, Adana, Turkey.

出版信息

J BUON. 2014 Apr-Jun;19(2):453-8.

PMID:24965406

Abstract

PURPOSE

Cigarette smoking was regarded as the most important carcinogenic factor of lung cancer, yet in recent years lung cancer in never-smokers is an increasingly prominent public health issue. The aim of this study was to assess the epidemiological and clinicopathological characteristics of never-smoker patients with non small cell lung cancer (NSCLC), focusing on clinical risk factors and survival.

METHODS

We retrospectively analyzed 290 NSCLC patients who presented between 2006 and 2011. Differences in clinical features and survival between never- and ever- smoker patients were analyzed. Student's t-test and Mann-Whitney U-test were used to assess the significance of the variables between the groups. Survival curves were calculated using Kaplan-Meier method. Hazard ratio (HR) for death and its 95% confidence interval (CI) were calculated by Cox regression analysis.

RESULTS

There were 243 (83.8%) ever-smokers and 47 (16.2%) never-smokers. In never-smokers females predominated (80.9%) as well as patients with adenocarcinomas (78.7%). At the time of analysis 143 (49.3%) patients had died. The 5-year overall survival (OS) rates were not significantly different between never- and ever-smokers (p=0.410) . The median OS of all patients was 26 months (95% CI: 16.8-35.2). The median OS was 23 months (95% CI: 11.8- 34.2) for never-smokers and 30 months ∥95% CI: 19.7-40.3) for ever-smokers (p=0.410). Never-smokers tended to present with more advanced disease than ever-smokers (p<0.004) and also with more advanced age (p<0.001). The HR for death increased with poorer Eastern Cooperative Oncology Group ( ECOG ) performance status (PS) (ECOG 2=3), advanced stage (stage 3=4) and untreated patients. Slightly lower risk for death was registered in patients with adenocarcinoma vs those with squamous cell carcinoma (SCC).

CONCLUSION

Although no difference in survival was seen, definite epidemiologic differences do exist between never- smokers and ever-smokers patients with NSCLC. Future efforts should focus on the underlying biological differences, and on identifying potential non-tobacco related risk factors in order to improve treatment strategies for these two groups of NSCLC patients.

摘要

目的

吸烟曾被视为肺癌最重要的致癌因素，但近年来，从不吸烟者患肺癌已成为一个日益突出的公共卫生问题。本研究旨在评估非小细胞肺癌（NSCLC）从不吸烟患者的流行病学和临床病理特征，重点关注临床危险因素和生存率。

方法

我们回顾性分析了2006年至2011年间就诊的290例NSCLC患者。分析了从不吸烟患者与曾经吸烟患者在临床特征和生存率方面的差异。采用学生t检验和曼-惠特尼U检验评估组间变量的显著性。使用Kaplan-Meier方法计算生存曲线。通过Cox回归分析计算死亡风险比（HR）及其95%置信区间（CI）。

结果

有243例（83.8%）曾经吸烟者和47例（16.2%）从不吸烟者。从不吸烟者中女性占主导（80.9%），腺癌患者也占主导（78.7%）。在分析时，143例（49.3%）患者已死亡。从不吸烟患者与曾经吸烟患者的5年总生存率（OS）无显著差异（p = 0.410）。所有患者的中位OS为26个月（95%CI：16.8 - 35.2）。从不吸烟者的中位OS为23个月（95%CI：11.8 - 34.），曾经吸烟者为30个月（95%CI：19.7 - 40.3）（p = 0.410）。从不吸烟者比曾经吸烟者更倾向于表现为疾病进展更严重（p < 0.004），且年龄也更大（p < 0.001）。死亡HR随着东部肿瘤协作组（ECOG）体能状态（PS）较差（ECOG 2 = 3）、疾病晚期（3期 = 4期）和未接受治疗的患者而增加。腺癌患者的死亡风险略低于鳞状细胞癌（SCC）患者。