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Prognostic Impact of Smoking Period in Patients with Surgically Resected Non-small Cell Lung Cancer

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The pack-year index, which is calculated by multiplying a smoking period by the number of cigarette packs smoked per day, is frequently used to investigate the risk of developing lung cancer. Notably, however, whether the smoking period or the number of packs per day is more predictive of postoperative prognosis remains unclear in non-small cell lung cancer (NSCLC) patients who receive curative lung resection.

Patients and Methods

Initial screening included 2055 consecutive lung cancer patients who had underwent curative lung resection between 2000 and 2016 at a single center in Japan. Data from 1134 NSCLC patients with smoking history were ultimately analyzed. Time-dependent areas under the curve (AUCs) were used to compare diagnostic accuracy.

Results

On univariate analysis, the number of packs smoked per day was not a significant predictor of disease-free survival (DFS; p = 0.2387) or overall survival (OS; p = 0.1357). On multivariable analysis, smoking period was an independent predictor of DFS and OS (both p < 0.0001). Time-dependent smoking period AUCs were superior to those of number of packs smoked per day. On subgroup analyses, patients with a smoking period ≥ 40 years had significantly shorter DFS and OS than those with a smoking period of < 40 years, independent of sex, clinical stage, and histological type.

Conclusions

Smoking period was a significant prognostic indicator in NSCLC patients who underwent curative lung resection, which should be validated in further prospective and/or multicenter studies with large sample sizes.

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Acknowledgements

We thank Dr Owen Proudfoot from Edanz Group (www.edanzediting.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Shinkichi Takamori MD, PhD, Taichi Matsubara MD, PhD, Naoki Haratake MD, PhD, Ryo Toyozawa MD, Naoko Miura MD, PhD, Masafumi Yamaguchi MD, PhD, Takashi Seto MD, PhD, Tatsuro Okamoto MD, PhD & Mitsuhiro Takenoyama MD, PhD

  2. Department of Biostatistics, Yamaguchi University Graduate School of Medicine, Ube, Japan

    Mototsugu Shimokawa MD, PhD

  3. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Tetsuzo Tagawa MD, PhD & Masaki Mori MD, PhD

  4. Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan

    Yoshihiko Maehara MD, PhD

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  1. Shinkichi Takamori MD, PhD
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Correspondence to Shinkichi Takamori MD, PhD.

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Disclosures

Takashi Seto received grants and personal fees from AstraZeneca, grants and personal fees from Chugai Pharmaceutical, grants and personal fees from Daiichi Sankyo, grants and personal fees from Eli Lilly Japan, grants and personal fees from MSD, grants and personal fees from Nippon Boehringer Ingelheim, grants and personal fees from Novartis Pharma, grants and personal fees from Pfizer Japan, grants and personal fees from Takeda Pharmaceutical, personal fees from Astellas Pharma, personal fees from Bristol-Myers Squibb, personal fees from Kyowa Hakko Kirin, personal fees from Ono Pharmaceutical, personal fees from Taiho Pharmaceutical, personal fees from Thermo Fisher Scientific, grants from Abbvie, grants from Bayer Yakuhin, grants from Kissei Pharmaceutical, grants from LOXO Oncology, grants from Merck Serono, and personal fees from Precision Medicine Asia Co. Ltd., outside the submitted work. Tetsuzo tagawa received grants from Chugai Pharmaceutical and Roche Diagnostics. Masaki Mori received grants from Chugai Pharmaceutical. All the other authors declare no conflicts of interest.

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Supplementary Fig. 1.

Study design and inclusion and exclusion criteria. The study focuses on non-small cell lung cancer patients with a history of smoking who underwent curative lung resection (TIFF 2787 kb)

Supplementary Fig. 2.

Distributions of (A) smoking period and (B) number of packs smoked per day (TIFF 2787 kb)

Supplementary Fig. 3.

Receiver operating characteristic curve for 5-year survival showing that the best cut-off of smoking period was 40 year (64.5% sensitivity and 57.3% specificity; area under curve = 0.636) (TIFF 2787 kb)

Supplementary Fig. 4.

Kaplan–Meier curves comparing postoperative survival by smoking status (≥ 40 years versus never smoker) (TIFF 2787 kb)

Supplementary material 5 (DOCX 23 kb)

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Takamori, S., Shimokawa, M., Matsubara, T. et al. Prognostic Impact of Smoking Period in Patients with Surgically Resected Non-small Cell Lung Cancer. Ann Surg Oncol 28, 685–694 (2021). https://doi.org/10.1245/s10434-020-08851-6

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  • DOI: https://doi.org/10.1245/s10434-020-08851-6

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