Division of Medical Oncology, National Cancer Centre, Singapore.
Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre, Singapore.
Clin Lung Cancer. 2018 Sep;19(5):e539-e550. doi: 10.1016/j.cllc.2018.03.013. Epub 2018 Mar 17.
It is not known whether clinicopathologic characteristics, treatment, and survival of never-smokers among lung cancer incident cases have changed over time. We assessed the trend and overall survival (OS) of these patients within our institution during a 10-year period.
We reviewed 2 cohorts of non-small-cell lung cancer patients with a diagnosis from 1999 to 2002 and from 2008 to 2011. The patient characteristics and OS were compared by smoking status within each cohort and between the 2 cohorts over time.
Of the 992 patients in the 1999-2002 cohort and the 1318 patients in the 2008-2011 cohort, 902 and 1272 had a known smoking status, respectively. The proportion of never-smokers increased from 31% in 1999-2002 to 48% in 2008-2011 (P < .001). Within both cohorts, the differences in characteristics among never-, former-, and current-smokers have remained largely constant over time. A greater proportion of never-smokers had Eastern Cooperative Oncology Group performance status 0 to 1 and adenocarcinoma. The median OS increased from 15.5 months in 1999-2002 to 24.9 months in 2008-2011 (P = .001) for never-smokers, 12.3 to 15.9 months (P = .150) for former-smokers, and 10.5 to 13.9 months (P = .011) for current-smokers. The larger survival improvement among never-smokers was likely accounted for by the larger increase in never-smokers who were treated with tyrosine kinase inhibitors and pemetrexed over time.
We found an increasing trend of never-smokers among incident lung cancer cases and improved survival for these patients during a 10-year period. The documentation of smoking status in any national cancer registry is vital to estimate the true incidence of lung cancer among never-smokers over time.
目前尚不清楚肺癌新发病例中从不吸烟者的临床病理特征、治疗方法和生存情况是否随时间发生了变化。我们评估了本机构在 10 年内这些患者的趋势和总生存（OS）。
我们回顾了 1999 年至 2002 年和 2008 年至 2011 年两个队列的非小细胞肺癌患者。通过每个队列内和两个队列之间的吸烟状态比较患者特征和 OS。
在 1999-2002 年队列的 992 例患者和 2008-2011 年队列的 1318 例患者中，分别有 902 例和 1272 例患者的吸烟状况已知。从不吸烟者的比例从 1999-2002 年的 31%增加到 2008-2011 年的 48%（P<.001）。在两个队列中，从不吸烟者、前吸烟者和现吸烟者之间的特征差异随时间基本保持不变。从不吸烟者中有更大比例的东部合作肿瘤学组表现状态 0 至 1 和腺癌。从不吸烟者的中位 OS 从 1999-2002 年的 15.5 个月增加到 2008-2011 年的 24.9 个月（P=.001），前吸烟者从 12.3 个月增加到 15.9 个月（P=.150），现吸烟者从 10.5 个月增加到 13.9 个月（P=.011）。从不吸烟者的生存改善更大，可能是由于随时间推移，接受酪氨酸激酶抑制剂和培美曲塞治疗的从不吸烟者数量增加。
我们发现肺癌新发病例中从不吸烟者的趋势呈上升趋势，这些患者的生存在 10 年内有所改善。在任何国家癌症登记处记录吸烟状况对于随着时间的推移估计从不吸烟者中肺癌的真实发病率至关重要。
