Clément-Duchêne Christelle, Stock Shannon, Xu Xiangyan, Chang Ellen T, Gomez Scarlett Lin, West Dee W, Wakelee Heather A, Gould Michael K
1 Department of Medicine, Stanford Cancer Institute, and.
2 Respiratory Diseases Department, University Hospital, Vandoeuvre-lès-Nancy, France.
Ann Am Thorac Soc. 2016 Jan;13(1):58-66. doi: 10.1513/AnnalsATS.201504-241OC.
Differences in patient characteristics and outcomes have been observed among current, former, and never-smokers with lung cancer, but most prior studies included few never-smokers and were not prospective.
We used data from a large, prospective study of lung cancer care and outcomes in the United States to compare characteristics of never-smokers and smokers with lung cancer and to examine survival among the never-smokers.
Smoking status at diagnosis was determined by self-report and survival was determined from medical records and cancer registries, with follow-up through June 2010 or later. Cox regression was used to examine the association between smoking and survival, and to identify predictors of survival among never-smokers.
Among 3,410 patients with lung cancer diagnosed between September 1, 2003 and October 14, 2005 who completed a baseline patient survey, there were 274 never-smokers (8%), 1,612 former smokers (47%), 1,496 current smokers or smokers who quit recently (44%), and 28 with missing information about smoking status (<1%). Never-smokers appeared more likely than former and current/recent smokers to be female and of Asian or Hispanic race/ethnicity, and to have adenocarcinoma histology, fewer comorbidities, private insurance, and higher income and education. Compared with never-smokers, the adjusted hazard of death from any cause was 29% higher among former smokers (hazard ratio, 1.29; 95% confidence interval, 1.08-1.55), and 39% higher among current/recent smokers (hazard ratio, 1.39; 95% confidence interval, 1.16-1.67). Factors predicting worse overall survival among never-smokers included Hispanic ethnicity, severe comorbidity, undifferentiated histology, and regional or distant stage. Never-smoking Hispanics appeared more likely to have regional or advanced disease at diagnosis and less likely to undergo surgical resection, although these differences were not statistically significant.
Never-smokers with lung cancer are more likely than ever-smokers to be female, Asian or Hispanic, and more advantaged socioeconomically, suggesting possible etiologic differences in lung cancer by smoking status. Among never-smokers, Hispanics with lung cancer had worse survival than non-Hispanic whites.
在患有肺癌的当前吸烟者、既往吸烟者和从不吸烟者中，已观察到患者特征和预后存在差异，但大多数既往研究纳入的从不吸烟者很少，且并非前瞻性研究。
我们使用来自美国一项关于肺癌治疗与预后的大型前瞻性研究的数据，比较肺癌从不吸烟者和吸烟者的特征，并研究从不吸烟者的生存率。
通过自我报告确定诊断时的吸烟状态，从医疗记录和癌症登记处确定生存率，随访至2010年6月或更晚。采用Cox回归分析吸烟与生存之间的关联，并确定从不吸烟者生存的预测因素。
在2003年9月1日至2005年10月14日期间诊断为肺癌且完成基线患者调查的3410例患者中，有274例从不吸烟者（8%），1612例既往吸烟者（47%），1496例当前吸烟者或近期戒烟者（44%），28例吸烟状态信息缺失者（<1%）。从不吸烟者比既往吸烟者和当前/近期吸烟者更可能为女性、亚洲或西班牙裔种族/族裔，且组织学类型为腺癌、合并症较少、有私人保险、收入和教育水平较高。与从不吸烟者相比，既往吸烟者因任何原因死亡的校正风险高29%（风险比，1.29；95%置信区间，1.08 - 1.55），当前/近期吸烟者高39%（风险比，1.39；95%置信区间，1.16 - 1.67）。预测从不吸烟者总体生存较差的因素包括西班牙裔种族/族裔、严重合并症、未分化组织学类型以及区域或远处分期。从不吸烟的西班牙裔在诊断时似乎更可能患有区域或晚期疾病，且接受手术切除的可能性较小，尽管这些差异无统计学意义。
肺癌从不吸烟者比吸烟者更可能为女性、亚洲或西班牙裔，且社会经济状况更优，提示肺癌病因可能因吸烟状态而异。在从不吸烟者中，患有肺癌的西班牙裔生存率低于非西班牙裔白人。
