Thoracic Surgical Services, RWJBarnabas Health, 101 Old Short Hills Road, West Orange, NJ, 07052, USA.
Department of Surgery, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, NJ, 07112, USA.
World J Surg. 2022 Jan;46(1):265-271. doi: 10.1007/s00268-021-06311-0. Epub 2021 Sep 30.
Smoking is a known risk factor for perioperative complications after lung resection; however, little data exists looking at the impact of smoking status (current versus former) on long-term oncologic outcomes after lung cancer surgery. We sought to compare overall survival (OS), progression-free survival (PFS), and cancer-specific mortality (CSM) in current and former smokers using data from the National Lung Screening Trial (NLST). Additionally, we performed subset analysis in current smokers in order to evaluate the effect of modern surgical techniques on long-term outcomes.
Patients with clinical stage IA or IB NSCLC who underwent upfront resection within 180 days of diagnosis were identified in the NLST database. Cox proportional hazard regression models were used to assess differences in patient and treatment characteristics with respect to OS and PFS, with a cause-specific hazard model used for CSM.
A total of 593 patients were included in the study (269 former smokers, 324 current smokers). Lobar resection (LR) was performed more often than sublobar resection (SLR) (481 vs. 112), and thoracotomy was performed more often than thoracoscopy (482 vs. 86). Comparison of current versus former smokers showed no difference in OS or PFS after resection. Higher CSM was seen in current smokers (p = 0.049). Subset analysis of current smokers revealed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Although higher CSM was associated with thoracoscopy versus thoracotomy in this group, this finding was limited by a relatively small thoracoscopy sample size of 44 patients (p = 0.026).
Our analysis of the NLST database shows no significant difference in OS and PFS when comparing current and former smokers undergoing resection for stage I NSCLC. Active smoking status was associated with higher CSM. Subset analysis of current smokers showed no difference in OS or PFS between sub-lobar and lobar resection or thoracotomy and thoracoscopy. Higher CSM was seen in current smokers who underwent thoracoscopy compared to thoracotomy; however, this finding was limited by a small sample size.
吸烟是肺切除术后围手术期并发症的已知危险因素；然而，关于吸烟状况（当前吸烟与既往吸烟）对肺癌手术后长期肿瘤学结果的影响的数据很少。我们试图使用国家肺癌筛查试验（NLST）的数据来比较当前和既往吸烟者的总生存（OS）、无进展生存（PFS）和癌症特异性死亡率（CSM）。此外，我们对当前吸烟者进行了亚组分析，以评估现代手术技术对长期结果的影响。
在 NLST 数据库中，确定了在诊断后 180 天内接受直接切除术的临床分期 IA 或 IB NSCLC 患者。使用 Cox 比例风险回归模型评估患者和治疗特征与 OS 和 PFS 的差异，使用特定于原因的风险模型评估 CSM。
共有 593 例患者纳入研究（269 例既往吸烟者，324 例当前吸烟者）。肺叶切除术（LR）比亚肺叶切除术（SLR）更常见（481 例比 112 例），开胸术比胸腔镜更常见（482 例比 86 例）。当前吸烟者与既往吸烟者比较，切除后 OS 或 PFS 无差异。当前吸烟者的 CSM 更高（p=0.049）。当前吸烟者的亚组分析显示，SLR 与 LR 或开胸术与胸腔镜之间的 OS 或 PFS 无差异。尽管在这组患者中，与开胸术相比，胸腔镜与较高的 CSM 相关，但由于胸腔镜样本量相对较小（44 例），这一发现受到限制（p=0.026）。
我们对 NLST 数据库的分析显示，在比较接受 I 期 NSCLC 切除术的当前吸烟者和既往吸烟者时，OS 和 PFS 无显著差异。吸烟状态与较高的 CSM 相关。当前吸烟者的亚组分析显示，SLR 与 LR 或开胸术与胸腔镜之间的 OS 或 PFS 无差异。与开胸术相比，接受胸腔镜的当前吸烟者的 CSM 较高；然而，这一发现受到样本量较小的限制。
