Sekihara Keigo, Kawase Akikazu, Matsubayashi Yuta, Tajiri Tomoya, Shibata Motohisa, Hayakawa Takamitsu, Shiiya Norihiko, Funai Kazuhito
First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Jul 3;39(1). doi: 10.1093/icvts/ivae109.
Smokers comprise the majority of surgical patients with primary lung cancer. Epidermal growth factor receptor (EGFR) mutation-negative status impacts the treatment of recurrence. However, the prognostic impact of cigarette smoking stratified by EGFR mutation status has not been reported. Therefore, we assessed its impact on patients with resected lung cancer.
We retrospectively analysed 362 consecutive patients who underwent complete resection for stage 1 primary lung cancer at our institution between 2012 and 2021. The EGFR mutation status was evaluated using the real-time polymerase chain reaction. We compared the overall survival (OS) and disease-free survival (DFS) between patients with and without a history of smoking.
The EGFR mutation-negative group included 194 patients, of whom 160 (83%) had a history of smoking. Male sex (P < 0.01), forced expiratory volume in 1 s (P < 0.01) and adenocarcinoma (P < 0.01) showed significant differences between the groups. In the EGFR mutation-positive group, the 5-year OS and DFS were similar regardless of smoking status (OS: 86% vs 75%; DFS: 73% vs 73%). In the EGFR mutation-negative group, the 5-year OS and DFS were significantly poorer in the smoking group (OS: 87% vs 65%, P = 0.05; DFS: 84% vs 54%, P = 0.01). Deaths from other diseases were relatively high (n = 19, 53%).
Cigarette smoking may be associated with a poor prognosis in EGFR mutation-negative lung cancer but had no impact on the prognosis of the EGFR mutation-positive group. This finding underscores the potential influence of smoking on the treatment of lung cancer recurrence but also highlights its significance in contributing to death from other diseases.
吸烟者占原发性肺癌手术患者的大多数。表皮生长因子受体（EGFR）突变阴性状态会影响复发治疗。然而，按EGFR突变状态分层的吸烟对预后的影响尚未见报道。因此，我们评估了其对接受肺癌切除术患者的影响。
我们回顾性分析了2012年至2021年间在本机构接受一期原发性肺癌根治性切除的362例连续患者。采用实时聚合酶链反应评估EGFR突变状态。我们比较了有吸烟史和无吸烟史患者的总生存期（OS）和无病生存期（DFS）。
EGFR突变阴性组包括194例患者，其中160例（83%）有吸烟史。两组在男性（P＜0.01）、一秒用力呼气量（P＜0.01）和腺癌（P＜0.01）方面存在显著差异。在EGFR突变阳性组中，无论吸烟状态如何，5年总生存期和无病生存期相似（总生存期：86%对75%；无病生存期：73%对73%）。在EGFR突变阴性组中，吸烟组的5年总生存期和无病生存期明显较差（总生存期：87%对65%，P = 0.05；无病生存期：84%对54%，P = 0.01）。其他疾病导致的死亡相对较高（n = 19，53%）。
吸烟可能与EGFR突变阴性肺癌的预后不良有关，但对EGFR突变阳性组的预后无影响。这一发现强调了吸烟对肺癌复发治疗的潜在影响，但也凸显了其在导致其他疾病死亡方面的重要性。
