Clinical Research Centre, Prince Philip Hospital, Llanelli, UK; Hywel Dda University Health Board, Wales, SA14 8QF, UK.
Hywel Dda University Health Board, Wales, SA14 8QF, UK.
Lung Cancer. 2019 Mar;129:1-7. doi: 10.1016/j.lungcan.2018.12.028. Epub 2018 Dec 28.
To update the prevalence of smoking in people as they were diagnosed with non-small cell lung cancer (NSCLC) and to see whether smoking status at baseline and quitting are independently associated with 1-year survival.
A real-world cohort study following patients from diagnosis for up to 1 year or until death.
UK multi-centre study (28 sites) based in secondary and primary care.
1124 patients with newly diagnosed NSCLC between 2010-2016.
Smoking status was validated at diagnosis and at every routine and emergency hospital visit. Cancer treatments were offered according to local multi-disciplinary team decisions following UK guidelines and smoking cessation treatments offered according to local practice /availability. Survival analysis and Cox Proportional Hazards Modelling examined the associations of a) smoking at baseline and b) quitting smoking, on survival at 1 year.
77% of never smokers, 60% of ex-smokers and 57% of current smokers, were alive at 1 year (p = 0.01). After adjusting for age, stage, EGOG, surgery and gender, ex smokers (adjusted HR 1.96, 95% CI 1.16-2.31) and current smokers (aHR 2.04, 1.19-3.48) were both more likely to die within one year. 23% of smokers with NSCLC quit within 3 months of diagnosis. At 1 year, 69% of those who quit were alive versus 53% of those who continued to smoke (p < 0.01). After adjusting the risk of dying was lower (aHR 0.75), in those who quit smoking, although this was not statistically significant (p = 0.23).
This is the largest prospective study that validates smoking in NSCLC; it shows a third of people are smoking at the time of diagnosis. Smokers have lower 12-month survival than never and ex -smokers. Quitting smoking was associated with 25% reduction in mortality which may be clinically important although not statistically significant, after adjusting for other factors.
更新非小细胞肺癌（NSCLC）患者确诊时的吸烟率，并探讨基线时的吸烟状况和戒烟是否与 1 年生存率独立相关。
一项真实世界的队列研究，对 2010 年至 2016 年间确诊的 NSCLC 患者进行为期 1 年或直至死亡的随访。
英国多中心研究（28 个研究点），基于二级和初级保健。
1124 名新诊断为 NSCLC 的患者。
在诊断时以及每次常规和紧急医院就诊时验证吸烟状况。癌症治疗根据英国指南和当地多学科团队的决定提供，戒烟治疗根据当地实践/可及性提供。生存分析和 Cox 比例风险模型分析了基线吸烟状况 a）和戒烟 b）与 1 年生存率的关系。
1 年后，从不吸烟者、曾经吸烟者和当前吸烟者的存活率分别为 77%、60%和 57%（p=0.01）。调整年龄、分期、ECOG、手术和性别后，与从不吸烟者相比，曾经吸烟者（调整后的 HR 1.96，95%CI 1.16-2.31）和当前吸烟者（调整后的 HR 2.04，1.19-3.48）在 1 年内死亡的风险更高。23%的 NSCLC 吸烟者在确诊后 3 个月内戒烟。1 年后，戒烟者的存活率为 69%，而继续吸烟者的存活率为 53%（p<0.01）。调整后，戒烟者的死亡风险较低（调整后的 HR 0.75），但差异无统计学意义（p=0.23）。
这是迄今为止最大的前瞻性研究，验证了 NSCLC 患者的吸烟状况，表明三分之一的患者在确诊时正在吸烟。吸烟者的 12 个月生存率低于从不吸烟者和曾经吸烟者。戒烟与死亡率降低 25%相关，这可能具有临床意义，尽管在调整其他因素后差异无统计学意义。
