Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Weill Cornell Medicine, Cornell University, New York-Presbyterian Hospital, New York, NY, USA.
Eur J Cardiothorac Surg. 2018 Apr 1;53(4):842-848. doi: 10.1093/ejcts/ezx390.
We sought to examine changes over time in the proportion of never smokers among surgical lung cancer patients and to determine whether smoking history affected survival.
We performed a retrospective review of a prospective database. Among never smokers and smokers, demographic and pathological data were compared. Disease-free survival (DFS) and cancer-specific survival (CSS) were analysed. Propensity matching was performed for further comparison of survival in a matched cohort.
Among 3232 patients, we identified 718 never smokers (22%), 993 smokers with <30 pack history (31%) and 1521 smokers with ≥30 pack history (47%). The proportion of never smokers increased over time, comprising 26.6% of the cohort after 2007 compared with 16.1% prior thereto (P ≤ 0.001). Never smokers were younger, more likely to be women and Asian, more frequently had adenocarcinoma and lower lobe tumours and were more likely to have pStage I disease. In pStage-matched cohorts, there were no differences in DFS or CSS. Similarly, in propensity-matched groups (498 patients each), there was no difference in 5-year DFS (66% vs 67%, P = 0.661) or in CSS (84% vs 81%, P = 0.350). On univariate analysis of the matched cohort, never smoking status had no effect on DFS (hazard ratio 1.05, P = 0.661) or CSS (hazard ratio 1.16, P = 0.350).
The proportion of never smokers undergoing resections for lung cancer is increasing. Never smokers have distinct demographic patterns and tend to be younger women with adenocarcinoma. Despite these differences, stage and propensity-matched never smokers have the same survival as smokers and remain at equal risk for recurrence and death.
我们旨在研究手术治疗肺癌患者中从不吸烟者的比例随时间的变化，并确定吸烟史是否影响生存。
我们对前瞻性数据库进行了回顾性研究。在从不吸烟者和吸烟者中，比较了人口统计学和病理学数据。分析了无病生存期（DFS）和癌症特异性生存期（CSS）。进行倾向匹配以进一步比较匹配队列中的生存情况。
在 3232 名患者中，我们确定了 718 名从不吸烟者（22%）、993 名吸烟史<30 包（31%）和 1521 名吸烟史≥30 包（47%）的患者。从不吸烟者的比例随时间增加，与 2007 年之前相比，2007 年后队列中从不吸烟者的比例从 16.1%增加到 26.6%（P≤0.001）。从不吸烟者更年轻，更可能是女性和亚洲人，更常患有腺癌和下叶肿瘤，更可能患有 p 期 I 期疾病。在 p 期匹配队列中，DFS 或 CSS 无差异。同样，在倾向匹配组（每组 498 名患者）中，5 年 DFS（66%比 67%，P=0.661）或 CSS（84%比 81%，P=0.350）无差异。在匹配队列的单因素分析中，从不吸烟状态对 DFS（风险比 1.05，P=0.661）或 CSS（风险比 1.16，P=0.350）没有影响。
接受肺癌切除术的从不吸烟者的比例正在增加。从不吸烟者具有明显的人口统计学模式，往往是年轻的女性，患有腺癌。尽管存在这些差异，但分期和倾向匹配的从不吸烟者的生存情况与吸烟者相同，复发和死亡的风险相同。
