Park Ha-Young, Oh Hyung-Joo, Park Hwa Kyung, Yoon Joon-Young, Yoon Chang-Seok, Kho Bo Gun, Kim Tae-Ok, Shin Hong-Joon, Park Chul-Kyu, Kwon Yong-Soo, Kim Yu-Il, Lim Sung-Chul, Kim Young-Chul, Oh In-Jae
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
Lung Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea.
Tuberc Respir Dis (Seoul). 2025 Apr;88(2):334-341. doi: 10.4046/trd.2024.0056. Epub 2025 Feb 11.
Small cell lung cancer (SCLC) is called 'smoker's disease' because it is strongly associated with smoking and most cases occur in smokers. However, it can also occur in never smokers. We investigated the clinical features of never smokers with SCLC and compared their treatment outcomes with those of smokers with SCLC.
We retrospectively reviewed the clinical data of patients who had proven SCLC and had received chemotherapy at a single cancer center between July 2002 and April 2021.
Of 1,643 patients, 1,416 (86.2%) were enrolled in this study. A total of 162 (11.4%) and 1,254 (88.6%) patients were never smokers and smokers, respectively. There were more female never smokers than smokers (n=130; 80.2% vs. 79, 6.3%, p=0.000), and the incidence of ischemic heart disease was lower among never smokers than among smokers (4/1,416, [2.5%] vs. 83/1,416 [6.6%], p=0.036). Never smokers showed less symptoms at diagnosis than smokers (80.9% vs. 87.2%, p=0.037); however, they showed more toxicity after first-line treatment (61.7% vs. 47.8%, p=0.001). The objective response rate (ORR) was significantly higher in never smokers (74.1% vs. 59.6%, p=0.000). In the multivariate analysis, never smoking and second-line treatment were associated with a better ORR. However, progression-free survival and overall survival were not significantly different between never smokers and smokers.
In conclusion, never smokers accounted for 11.4% of patients with SCLC. They had distinguishing clinical characteristics and showed better chemotherapeutic responses than smokers.
小细胞肺癌（SCLC）被称为“吸烟者疾病”，因为它与吸烟密切相关，且大多数病例发生在吸烟者中。然而，它也可发生在从不吸烟者中。我们调查了从不吸烟的小细胞肺癌患者的临床特征，并将他们的治疗结果与吸烟的小细胞肺癌患者进行比较。
我们回顾性分析了2002年7月至2021年4月期间在单一癌症中心确诊为小细胞肺癌并接受化疗的患者的临床资料。
在1643例患者中，1416例（86.2%）纳入本研究。从不吸烟者和吸烟者分别有162例（11.4%）和1254例（88.6%）。从不吸烟的女性患者比吸烟的女性患者多（n = 130；80.2%对79例，6.3%，p = 0.000），从不吸烟者缺血性心脏病的发病率低于吸烟者（1416例中有4例[2.5%]对1416例中有83例[6.6%]，p = 0.036）。从不吸烟者在诊断时的症状比吸烟者少（80.9%对87.2%，p = 0.037）；然而，他们在一线治疗后表现出更多的毒性（61.7%对47.8%，p = 0.001）。从不吸烟者的客观缓解率（ORR）显著更高（74.1%对59.6%，p = 0.000）。在多变量分析中，从不吸烟和二线治疗与更好的ORR相关。然而，从不吸烟者和吸烟者之间的无进展生存期和总生存期没有显著差异。
总之，从不吸烟者占小细胞肺癌患者的11.4%。他们具有独特的临床特征，并且比吸烟者表现出更好的化疗反应。
