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
. 2023 May 1;6(5):e2311966.
doi: 10.1001/jamanetworkopen.2023.11966.

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

Xinan Wang  1 , Christopher W Romero-Gutierrez  1 , Jui Kothari  1 , Andrea Shafer  2 , Yi Li  3 , David C Christiani  1   2
Affiliations

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

Xinan Wang et al. JAMA Netw Open. .

Abstract

Importance: Lung 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.

Objective: To 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 participants: The 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.

Exposures: Duration of smoking cessation before a lung cancer diagnosis.

Main outcomes and measures: The primary outcome was the association of detailed smoking history with OS following a lung cancer diagnosis.

Results: Of 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 relevance: In 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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure.
Figure.. Overall Survival Among Patients With Non–Small Cell Lung Cancer (NSCLC) by Smoking Status at Diagnosis
Graphs show survival among all patients with NSCLC (A), patients with early-stage NSCLC (B), and patients with late-stage NSCLC (C).
See this image and copyright information in PMC

References

    1. National Cancer Institute . SEER incidence data, 1975-2019, linked to county attributes-time dependent (1990-2018) income/rurality, 1969-2019 counties. April 2021, based on the November 2020 submission. Accessed March 28, 2023. https://seer.cancer.gov/data/
    1. Cronin KA, Scott S, Firth AU, et al. . Annual report to the nation on the status of cancer, part 1: national cancer statistics. Cancer. 2022;128(24):4251-4284. doi:10.1002/cncr.34479 - DOI - PMC - PubMed
    1. Duma N, Santana-Davila R, Molina JR. Non-small cell lung cancer: epidemiology, screening, diagnosis, and treatment. Mayo Clin Proc. 2019;94(8):1623-1640. doi:10.1016/j.mayocp.2019.01.013 - DOI - PubMed
    1. Lu T, Yang X, Huang Y, et al. . Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades. Cancer Manag Res. 2019;11:943-953. doi:10.2147/CMAR.S187317 - DOI - PMC - PubMed
    1. Debieuvre D, Locher C, Asselain B, et al. . Evidence of slight improvement in five-year survival in non-small-cell lung cancer over the last 10 years: results of the French KBP-CPHG real-world studies. Bull Cancer. 2019;106(4):283-292. doi:10.1016/j.bulcan.2019.01.010 - DOI - PubMed

Publication types