Prediagnosis Smoking Cessation and Overall Survival Among Patients With Non–Small Cell Lung Cancer

Abstract

ImportanceLung cancer remains the leading cause of cancer-related death globally; non–small cell lung cancer (NSCLC) accounts for 85% of all lung cancer cases, and cigarette smoking is the factor most significantly associated with its risk. However, little is known about the association of years since prediagnosis smoking cessation and cumulative smoking with overall survival (OS) following a lung cancer diagnosis.ObjectiveTo characterize the association of years since smoking cessation before diagnosis and cumulative smoking pack-years with OS in patients with NSCLC in a lung cancer survivor cohort.Design, Setting, and ParticipantsThe cohort study involved patients with NSCLC who were recruited to the Boston Lung Cancer Survival Cohort at Massachusetts General Hospital (Boston, Massachusetts) between 1992 and 2022. Patients’ smoking history and baseline clinicopathological characteristics were prospectively collected through questionnaires, and OS following lung cancer diagnosis was regularly updated.ExposuresDuration of smoking cessation before a lung cancer diagnosis.Main Outcomes and MeasuresThe primary outcome was the association of detailed smoking history with OS following a lung cancer diagnosis.ResultsOf 5594 patients with NSCLC (mean [SD] age, 65.6 [10.8] years; 2987 men [53.4%]), 795 (14.2%) were never smokers, 3308 (59.1%) were former smokers, and 1491 (26.7%) were current smokers. Cox regression analysis suggested that former smokers had 26% higher mortality (hazard ratio [HR], 1.26; 95% CI, 1.13-1.40; P < .001) and current smokers had 68% higher mortality (HR, 1.68; 95% CI, 1.50-1.89; P < .001) compared with never smokers. Log2-transformed years since smoking cessation before diagnosis were associated with significantly lower mortality among ever smokers (HR, 0.96; 95% CI, 0.93-0.99; P = .003). Subgroup analysis, stratified by clinical stage at diagnosis, revealed that former and current smokers had even shorter OS among patients with early-stage disease.Conclusions and RelevanceIn this cohort study of patients with NSCLC, quitting smoking early was associated with lower mortality following a lung cancer diagnosis, and the association of smoking history with OS may have varied depending on clinical stage at diagnosis, potentially owing to the differing treatment regimens and efficacy associated with smoking exposure following diagnosis. Detailed smoking history collection should be incorporated into future epidemiological and clinical studies to improve lung cancer prognosis and treatment selection.

The impact of social determinants of health on textbook oncological outcomes and overall survival in locally advanced non–small cell lung cancer

“…Numerous biological factors, including lung function, smoking status, obesity, cardiovascular disease, diabetes, and renal function, have implications for overall survival in patients with NSCLC. 30 , 31 However, the relationship between these biological risk factors and SDH remains inadequately characterized. Although it is plausible that patients with sociogeographic disadvantage indicators (SDH scores) may have more pronounced medical comorbidities that hinder treatment outcomes, the precise extent of the influence of these biological factors on the observed SDH-driven overall survival in both TOO+ and TOO– cases remains speculative.…”

Lung cancer statistics, 2023

“…123 Smoking cessation improves overall survival for patients who have lung cancer, with improvements in survival greater among women who quit smoking than among men. 124,125 Survival rates also vary by race and ethnicity, ranging from 26% among AAPI individuals to 19% among AIAN individuals (Figure 7), likely in part because of a higher frequency of EGFR mutations among AAPI individuals 123 among White women, whereas rates of small cell lung cancer are 17% higher (Figure 8). Higher survival may also be a result of fewer comorbid conditions.…”

Clinicopathological characteristics correlated with programmed cell death-ligand 1 expression in advanced lung adenocarcinoma

“…Lung cancer is the leading cause of cancer-related deaths globally ( 1 , 2 ). Among them, non-small cell lung cancer (NSCLC) is the most common histological type, accounting for more than 85% of the total number of patients ( 3 , 4 ), among which adenocarcinoma (ADC) accounts for nearly 60% of all NSCLC, making it the most common subtype of NSCLC.…”