The Impact of a Negative History of Smoking on Survival in Patients with Non-Small Cell Lung Cancer Detected with Clinic-based Screening Programs

Abstract

Objective The aim of this study was to determine the epidemiological characteristics of never-smoking patients with non-small cell lung cancer (NSCLC) detected with clinic-based screening programs, focusing on clinical risk factors and survival. Methods The medical records of NSCLC patients (n=285) diagnosed at Fujisawa City Hospital between April 2000 and December 2010 with lesions that were originally detected with clinic-based screening programs in Fujisawa City were reviewed to identify the clinicopathological variables and survival outcomes. Results Of the 285 NSCLC patients, 95 (33.3%) were never-smokers. A comparison between the neversmoking and ever-smoking patients revealed that the never-smokers included a significantly greater proportion of women and patients with adenocarcinoma (86.3% vs. 12.6%: p<0.001 or 94.7% vs. 55.8%: p<0.001, respectively). The overall survival rate of the never-smoking patients was significantly superior to that of the ever-smokers (p=0.004). In addition to smoking status, factors found to be significantly associated with the overall survival rate in univariate analyses were gender, stage, histology and first line treatment. A multivariate analysis revealed smoking status to be an independent prognostic factor in addition to stage and first line treatment. Conclusion The differences in the clinicopathological factors and survival outcomes between neversmoking and ever-smoking patients with NSCLC detected with clinic-based screening programs suggest that persuading people to never start smoking is important.

Role of Low-Dose Computerized Tomography in Lung Cancer Screening among Never-Smokers

“…The rate of lung cancer detected at an advanced stage in CT-screened subgroup was lower than the rates in group screened by radiography (22.1%) and group with screening prompted by symptoms (61.9%). From several reports described earlier in this article 7,13,14,19 and the present study, we found that cases of LCINS detected by CT screening were in an earlier stage than unscreened LCINS. We hopefully expect that LDCT screening in never-smokers will detect lung cancer in early stages and will therefore improve the survival of patients.…”

“…14 However, a study from Japan reported that 52% of LCINS detected in a clinicbased screening program were stage I and 35% were stage IIIB or IV. 13 Kondo et al 19 investigated the efficacy of CT screening for LCINS and reported that in the CT-screened subgroup, the rate of stage IA cancer was 69.7% whereas that of advanced stage was 6.6%. The rate of lung cancer detected at an advanced stage in CT-screened subgroup was lower than the rates in group screened by radiography (22.1%) and group with screening prompted by symptoms (61.9%).…”

“…Although survival of LCINS has been shown to be slightly better than survival of lung cancer in ever-smokers, many patients with LCINS eventually die as a result of delayed detection. 5,[11][12][13][14] Early detection is the only way to improve lung cancer outcomes. Over the past 40 years, many lung cancer screening trials with chest radiography or chest low-dose computerized tomography (LDCT) have been conducted in heavy smokers.…”

Lung Cancer in a Rural Area of China: Rapid Rise in Incidence and Poor Improvement in Survival

“…In China and other Asian countries, lung cancer has been the leading cause of cancer mortality for several years, and will remain so for the foreseeable future Marugame et al, 2009;D'Souza et al, 2013). Moreover, rates of both Nagakura et al, 2012), receipt of treatment, and socioeconomic inequalities or disparities in access to health care (Forrest et al, 2013).…”