Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009 Dec;66(3):386-92.
doi: 10.1016/j.lungcan.2009.02.012. Epub 2009 Mar 21.

Impact and interactions between smoking and traditional prognostic factors in lung cancer progression

Nancy L Guo  1 , Kursad Tosun, Kimberly Horn
Affiliations

Impact and interactions between smoking and traditional prognostic factors in lung cancer progression

Nancy L Guo et al. Lung Cancer. 2009 Dec.

Abstract

Background: Cigarette smoking is a well-known risk factor of lung carcinogenesis. The clinical impact of smoking on lung cancer metastases and survival remains unclear. We sought to investigate the effect of smoking intensity on lung cancer treatment failure (represented by overall survival), and the interactions between smoking and clinicopathological factors in lung cancer progression.

Methods: Clinical information was obtained from four non-small cell lung cancer patient cohorts (n=347). Twenty patients were excluded from the analysis because their smoking history was not available. The distribution of smoking intensity on patient age (> or =60 years or <60 years), gender, tumor differentiation (poor, moderate and well differentiated), and clinical stage (1, 2, or 3) was assessed with Kruskal-Wallis rank sum tests. The effect of smoking on cause-specific lung cancer mortality was estimated by using Cox proportional hazard models and Kaplan-Meier analysis. The interactions between clinicopathological factors and smoking intensity with regard to lung cancer overall survival were evaluated with analysis of variance (ANOVA) for Cox modeling.

Results: Greater smoking intensity at diagnosis was found in older patients (> or =60 years; p=0.022), male (p=1.35e-7), poorly differentiated tumors (p=8.51e-5), patients with tumor stage 2 (p=0.031), and squamous cell lung cancer patients (p=2.2e-16). Patients who smoked more than 61 packs/year had an increased risk for lung cancer recurrence (hazard ratio=1.41, 95% CI: [1.03, 1.94], log-rank p=0.032) and shorter overall survival period (log-rank p=0.033, Kaplan-Meier analysis) than those who smoked less than 61 packs/year. ANOVA analysis showed that smoking intensity (p=0.03) and tumor stage (p=1.2e-6) are the only significant prognostic factors of lung cancer, whereas patient age, gender, and tumor differentiation were not significant in lung cancer prognostication. There were significant interactions between smoking and clinical stage (p=0.02) as well as patient age and tumor differentiation (p=0.03) in lung cancer progression.

Conclusion: Smoking intensity at diagnosis is an independent, significant prognostic factor of non-small cell lung cancer. This factor could be used in patient selection for chemoprevention of tumor metastases and relapse. Additionally, the information may be used for clinically relevant tobacco prevention and intervention messages.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest statement

The authors do not have any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations that could inappropriately influence (bias) this work.

Figures

Figure 1
Figure 1
Distribution of smoking intensity on clinicopathological factors of non-small cell lung cancer, including (A) patient age, (B) gender, (C) tumor stage, (D) differentiation, and (E) histology.
Figure 2
Figure 2
Smoking intensity-defined patient groups had distinct overall survival in Kaplan-Meier analysis. In all figure panels, the upper curves represent patient group who smoked less than 61 packs/year, and the lower curves represent patient group who smoked more than 61 packs/year. A. Non-small cell lung cancer (NSCLC) patients who smoked less than 61 packs/year had longer (p = 0.033, log-rank test) postoperative survival periods than those who smoked more than 61 packs/year. B. Lung adenocarcinomas stratified by 61 packs/year did not have significant (p = 0.12) postoperative survival periods. C. Squamous cell lung cancers stratified by 61 packs/year did not have significant (p = 0.24) postoperative survival periods. D. Stage 1 NSCLC patients had significantly (p = 0.046) better prognosis in those who smoked less than 61 packs/year. E. Stage 2 NSCLC patients had better (p = 0.083) prognosis in those who smoked less than 61 packs/year. F. Stage 3 NSCLC patients had better (p = 0.067) prognosis in those who smoked less than 61 packs/year.
Figure 2
Figure 2
Smoking intensity-defined patient groups had distinct overall survival in Kaplan-Meier analysis. In all figure panels, the upper curves represent patient group who smoked less than 61 packs/year, and the lower curves represent patient group who smoked more than 61 packs/year. A. Non-small cell lung cancer (NSCLC) patients who smoked less than 61 packs/year had longer (p = 0.033, log-rank test) postoperative survival periods than those who smoked more than 61 packs/year. B. Lung adenocarcinomas stratified by 61 packs/year did not have significant (p = 0.12) postoperative survival periods. C. Squamous cell lung cancers stratified by 61 packs/year did not have significant (p = 0.24) postoperative survival periods. D. Stage 1 NSCLC patients had significantly (p = 0.046) better prognosis in those who smoked less than 61 packs/year. E. Stage 2 NSCLC patients had better (p = 0.083) prognosis in those who smoked less than 61 packs/year. F. Stage 3 NSCLC patients had better (p = 0.067) prognosis in those who smoked less than 61 packs/year.
Figure 2
Figure 2
Smoking intensity-defined patient groups had distinct overall survival in Kaplan-Meier analysis. In all figure panels, the upper curves represent patient group who smoked less than 61 packs/year, and the lower curves represent patient group who smoked more than 61 packs/year. A. Non-small cell lung cancer (NSCLC) patients who smoked less than 61 packs/year had longer (p = 0.033, log-rank test) postoperative survival periods than those who smoked more than 61 packs/year. B. Lung adenocarcinomas stratified by 61 packs/year did not have significant (p = 0.12) postoperative survival periods. C. Squamous cell lung cancers stratified by 61 packs/year did not have significant (p = 0.24) postoperative survival periods. D. Stage 1 NSCLC patients had significantly (p = 0.046) better prognosis in those who smoked less than 61 packs/year. E. Stage 2 NSCLC patients had better (p = 0.083) prognosis in those who smoked less than 61 packs/year. F. Stage 3 NSCLC patients had better (p = 0.067) prognosis in those who smoked less than 61 packs/year.
Figure 2
Figure 2
Smoking intensity-defined patient groups had distinct overall survival in Kaplan-Meier analysis. In all figure panels, the upper curves represent patient group who smoked less than 61 packs/year, and the lower curves represent patient group who smoked more than 61 packs/year. A. Non-small cell lung cancer (NSCLC) patients who smoked less than 61 packs/year had longer (p = 0.033, log-rank test) postoperative survival periods than those who smoked more than 61 packs/year. B. Lung adenocarcinomas stratified by 61 packs/year did not have significant (p = 0.12) postoperative survival periods. C. Squamous cell lung cancers stratified by 61 packs/year did not have significant (p = 0.24) postoperative survival periods. D. Stage 1 NSCLC patients had significantly (p = 0.046) better prognosis in those who smoked less than 61 packs/year. E. Stage 2 NSCLC patients had better (p = 0.083) prognosis in those who smoked less than 61 packs/year. F. Stage 3 NSCLC patients had better (p = 0.067) prognosis in those who smoked less than 61 packs/year.
Figure 2
Figure 2
Smoking intensity-defined patient groups had distinct overall survival in Kaplan-Meier analysis. In all figure panels, the upper curves represent patient group who smoked less than 61 packs/year, and the lower curves represent patient group who smoked more than 61 packs/year. A. Non-small cell lung cancer (NSCLC) patients who smoked less than 61 packs/year had longer (p = 0.033, log-rank test) postoperative survival periods than those who smoked more than 61 packs/year. B. Lung adenocarcinomas stratified by 61 packs/year did not have significant (p = 0.12) postoperative survival periods. C. Squamous cell lung cancers stratified by 61 packs/year did not have significant (p = 0.24) postoperative survival periods. D. Stage 1 NSCLC patients had significantly (p = 0.046) better prognosis in those who smoked less than 61 packs/year. E. Stage 2 NSCLC patients had better (p = 0.083) prognosis in those who smoked less than 61 packs/year. F. Stage 3 NSCLC patients had better (p = 0.067) prognosis in those who smoked less than 61 packs/year.
Figure 2
Figure 2
Smoking intensity-defined patient groups had distinct overall survival in Kaplan-Meier analysis. In all figure panels, the upper curves represent patient group who smoked less than 61 packs/year, and the lower curves represent patient group who smoked more than 61 packs/year. A. Non-small cell lung cancer (NSCLC) patients who smoked less than 61 packs/year had longer (p = 0.033, log-rank test) postoperative survival periods than those who smoked more than 61 packs/year. B. Lung adenocarcinomas stratified by 61 packs/year did not have significant (p = 0.12) postoperative survival periods. C. Squamous cell lung cancers stratified by 61 packs/year did not have significant (p = 0.24) postoperative survival periods. D. Stage 1 NSCLC patients had significantly (p = 0.046) better prognosis in those who smoked less than 61 packs/year. E. Stage 2 NSCLC patients had better (p = 0.083) prognosis in those who smoked less than 61 packs/year. F. Stage 3 NSCLC patients had better (p = 0.067) prognosis in those who smoked less than 61 packs/year.
See this image and copyright information in PMC

References

    1. Christiani DC. Genetic susceptibility to lung cancer. J Clin Oncol. 2006 Apr 10;24(11):1651–2. - PubMed
    1. Hoffman PC, Mauer AM, Vokes EE. Lung cancer. Lancet. 2000 Feb 5;355(9202):479–85. - PubMed
    1. Spira A, Ettinger DS. Multidisciplinary management of lung cancer. N Engl J Med. 2004 Jan 22;350(4):379–92. - PubMed
    1. Hung RJ, McKay JD, Gaborieau V, Boffetta P, Hashibe M, Zaridze D, Mukeria A, Szeszenia-Dabrowska N, Lissowska J, Rudnai P, et al. A susceptibility locus for lung cancer maps to nicotinic acetylcholine receptor subunit genes on 15q25. Nature. 2008 Apr 3;452(7187):633–7. - PubMed
    1. Beer DG, Kardia SL, Huang CC, Giordano TJ, Levin AM, Misek DE, Lin L, Chen G, Gharib TG, Thomas DG, et al. Gene-expression profiles predict survival of patients with lung adenocarcinoma. Nat Med. 2002 Aug;8(8):816–24. - PubMed

Publication types