BACKGROUND: The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. METHODS: In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. FINDINGS: Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1-3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87-0·97), patients with 3-5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83-0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87-0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81-0·93). Results were consistent across age, sex, histology, and disease-stage distributions. INTERPRETATION: In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. FUNDING: The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.

American Cancer Society Atlanta GA USA

Barbara Ann Karmanos Cancer Institute Wayne State University Detroit MI USA

Dalla Lana School of Public Health University of Toronto Toronto ON Canada

Dalla Lana School of Public Health University of Toronto Toronto ON Canada; Lunenfeld Tanenbaum Research Institute Sinai Health Systems Toronto ON Canada

Dartmouth Hitchcock Medical Center Lebanon NH USA

Department of Cancer Epidemiology and Prevention M Sklodowska Curie National Research Institute of Oncology Warsaw Poland

Department of Epidemiology School of Public Health Nanjing Medical University Nanjing China

Department of Health Sciences Research Mayo Clinic Rochester MN USA

Department of Health Sciences Research Mayo Clinic Rochester MN USA; Division of Pulmonary and Critical Care Medicine Jiangsu Province Hospital of Chinese Medicine Affiliated Hospital of Nanjing University of Chinese Medicine Nanjing China

Department of Oncology and Metabolism University of Sheffield Sheffield UK

Department of Oncology and Metabolism University of Sheffield Sheffield UK; Weston Park Cancer Centre Sheffield Teaching Hospital Foundation Trust Sheffield UK

Department of Preventive Medicine and Public Health University of Santiago de Compostela Santiago de Compostela Spain

Department of Preventive Medicine and Public Health University of Santiago de Compostela Santiago de Compostela Spain; Health Research Institute of Santiago de Compostela Santiago de Compostela Spain

Department of Thoracic Surgery Clinical Center of Serbia Belgrade Serbia

Department of Thoracic Surgery Fudan University Shanghai Cancer Center Shanghai China

Division of Clinical Epidemiology and Aging Research German Cancer Research Center Heidelberg Germany; Division of Preventive Oncology German Cancer Research Center Heidelberg Germany; National Center for Tumor Diseases German Cancer Research Center Heidelberg Germany; German Cancer Consortium German Cancer Research Center Heidelberg Germany

Division of Clinical Epidemiology and Aging Research German Cancer Research Center Heidelberg Germany; Network of Aging Research Heidelberg University Heidelberg Germany

Division of Genome Biology National Cancer Center Research Institute Tokyo Japan

Division of Genome Biology National Cancer Center Research Institute Tokyo Japan; Department of Clinical Genomics National Cancer Center Research Institute Tokyo Japan

Genomic Epidemiology Branch International Agency for Research on Cancer Lyon France

H Lee Moffitt Cancer Center and Research Institute Tampa FL USA

Harvard T H Chan School of Public Health Harvard University Boston MA USA

Institute of Public Health and Preventive Medicine and Department of Oncology 2nd Faculty of Medicine and University Hospital Motol Charles University Prague Czech Republic

Laboratory of Human Carcinogenesis Centre for Cancer Research National Institutes of Health Bethesda MD USA

M D Anderson Cancer Center University of Texas Houston TX USA

Molecular Oncology Research Center Barretos Cancer Hospital Barretos Brazil

Molecular Oncology Research Center Barretos Cancer Hospital Barretos Brazil; Life and Health Sciences Research Institute Medical School University of Minho Braga Portugal; Life and Health Sciences Research Institute Biomaterials Biodegradables and Biomimetics Research Group Associate Laboratory Braga Portugal

N N Blokhin National Medical Research Centre of Oncology Moscow Russia

National Cancer Institute National Institutes of Health Bethesda MD USA

National Institute of Public Health Bucharest Romania

Nofer Institute of Occupational Medicine Łódź Poland

Princess Margaret Cancer Centre and University Health Network University of Toronto Toronto ON Canada

Princess Margaret Cancer Centre and University Health Network University of Toronto Toronto ON Canada; Dalla Lana School of Public Health University of Toronto Toronto ON Canada

Princess Margaret Cancer Centre and University Health Network University of Toronto Toronto ON Canada; Division of Medical Oncology Faculty of Medicine of São José do Rio Preto São Paulo Brazil

Princess Margaret Cancer Centre and University Health Network University of Toronto Toronto ON Canada; State Key Laboratory of Respiratory Disease National Clinical Research Center for Respiratory Disease Guangzhou Institute of Respiratory Health 1st Affiliated Hospital of Guangzhou Medical University Guangzhou China

Princess Margaret Cancer Centre and University Health Network University of Toronto Toronto ON Canada; Universitätsklinik für Medizinische Onkologie Inselspital Bern Bern Switzerland

Program in Epidemiology Cancer Prevention Program Fred Hutchinson Cancer Center Seattle WA USA

Public Health Sciences Biostatistics Program Fred Hutchinson Cancer Center Seattle WA USA

Roy Castle Lung Cancer Research Programme Department of Molecular and Clinical Cancer Medicine University of Liverpool Liverpool UK

University Institute of Oncology of Asturias Cajastur Social Programme University of Oviedo Oviedo Spain; Health Research Institute of Asturias Oviedo Spain; Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública Oviedo Spain

University of Hawai'i Cancer Centre University of Hawai'i Honolulu HI USA

Lancet Public Health. 2023 Sep;8(9):e664-e665. doi: 10.1016/S2468-2667(23)00158-5. PubMed

Zobrazit více v PubMed

Blot WJ, Tarone RE. Doll and Peto’s quantitative estimates of cancer risks: holding generally true for 35 years. J Natl Cancer Inst 2015; 107: djv044. PubMed

Kessler M, Thumé E, Scholes S, et al. Modifiable risk factors for 9-year mortality in older English and Brazilian adults: the ELSA and SIGa-Bagé ageing cohorts. Sci Rep 2020; 10: 4375. PubMed PMC

Hecht SS. Cigarette smoking and lung cancer: chemical mechanisms and approaches to prevention. Lancet Oncol 2002; 3: 461–69. PubMed

Malhotra J, Malvezzi M, Negri E, La Vecchia C, Boffetta P. Risk factors for lung cancer worldwide. Eur Respir J 2016; 48: 889–902. PubMed

WHO International Agency for Research on Cancer. Lung. 2020. https://gco.iarc.fr/today/data/factsheets/cancers/15-Lung-fact-sheet. pdf (accessed June 19, 2023).

Herbst RS, Heymach JV, Lippman SM. Lung cancer. N Engl J Med 2008; 359: 1367–80. PubMed PMC

American Society of Clinical Oncology. Lung cancer—non-small cell: statistics. 2023. https://www.cancer.net/cancer-types/lung-cancer-non-small-cell/statistics (accessed June 19, 2023).

Dobson Amato KA, Hyland A, Reed R, et al. Tobacco cessation may improve lung cancer patient survival. J Thorac Oncol 2015; 10: 1014–19. PubMed PMC

Ferketich AK, Niland JC, Mamet R, et al. Smoking status and survival in the national comprehensive cancer network non-small cell lung cancer cohort. Cancer 2013; 119: 847–53. PubMed

Japuntich SJ, Kumar P, Pendergast JF, et al. Smoking status and survival among a national cohort of lung and colorectal cancer patients. Nicotine Tob Res 2019; 21: 497–504. PubMed PMC

Tindle HA, Stevenson Duncan M, Greevy RA, et al. Lifetime smoking history and risk of lung cancer: results from the Framingham Heart Study. J Natl Cancer Inst 2018; 110: 1201–07. PubMed PMC

Caini S, Del Riccio M, Vettori V, et al. Quitting smoking at or around diagnosis improves the overall survival of lung cancer patients: a systematic review and meta-analysis. J Thorac Oncol 2022; 17: 623–36. PubMed

US Public Health Service Office of the Surgeon General, US National Center for Chronic Disease Prevention and Health Promotion, US Office on Smoking and Health. Smoking cessation. 2020. https://www.ncbi.nlm.nih.gov/books/NBK555591 (accessed June 19, 2023).

de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med 2020; 382: 503–13. PubMed

Aberle DR, Adams AM, Berg CD, et al. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med 2011; 365: 395–409. PubMed PMC

Oudkerk M, Devaraj A, Vliegenthart R, et al. European position statement on lung cancer screening. Lancet Oncol 2017; 18: e754–66. PubMed

Fillon M. Pairing smoking cessation with lung cancer screening may save lives. CA Cancer J Clin 2021; 71: 283–84. PubMed

Fillon M. Smoking cessation support lags behind lung cancer screenings. CA Cancer J Clin 2022; 72: 405–06. PubMed

Wender R, Fontham ETH, Barrera E Jr, et al. American Cancer Society lung cancer screening guidelines. CA Cancer J Clin 2013; 63: 107–17. PubMed PMC

Williams RM, Cordon M, Eyestone E, et al. Improved motivation and readiness to quit shortly after lung cancer screening: evidence for a teachable moment. Cancer 2022; 128: 1976–86. PubMed PMC

Steliga MA, Yang P. Integration of smoking cessation and lung cancer screening. Transl Lung Cancer Res 2019; 8 (suppl 1): S88–94. PubMed PMC

Evans WK, Warren GW, Dresler C. Ignoring the obvious: smoking cessation improves survival. J Thorac Oncol 2022; 17: 596–98. PubMed

O’Malley M, King AN, Conte M, Ellingrod VL, Ramnath N. Effects of cigarette smoking on metabolism and effectiveness of systemic therapy for lung cancer. J Thorac Oncol 2014; 9: 917–26. PubMed

Alton D, Eng L, Lu L, et al. Perceptions of continued smoking and smoking cessation among patients with cancer. J Oncol Pract 2018; 14: e269–79. PubMed PMC

Shepshelovich D, Xu W, Lu L, et al. Body mass index (BMI), BMI change, and overall survival in patients with SCLC and NSCLC: a pooled analysis of the International Lung Cancer Consortium. J Thorac Oncol 2019; 14: 1594–607. PubMed PMC

Brenner DR, Boffetta P, Duell EJ, et al. Previous lung diseases and lung cancer risk: a pooled analysis from the International Lung Cancer Consortium. Am J Epidemiol 2012; 176: 573–85. PubMed PMC

Lundgreen CS, Larson DR, Atkinson EJ, et al. Adjusted survival curves improve understanding of multivariable cox model results. J Arthroplasty 2021; 36: 3367–71. PubMed PMC

Rich JT, Neely JG, Paniello RC, Voelker CCJ, Nussenbaum B, Wang EW. A practical guide to understanding Kaplan-Meier curves. Otolaryngol Head Neck Surg 2010; 143: 331–36. PubMed PMC

Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94: 496–509.

Tabuchi T, Goto A, Ito Y, Fukui K, Miyashiro I, Shinozaki T. Smoking at the time of diagnosis and mortality in cancer patients: what benefit does the quitter gain? Int J Cancer 2017; 140: 1789–95. PubMed

Ebbert JO, Williams BA, Sun Z, et al. Duration of smoking abstinence as a predictor for non-small-cell lung cancer survival in women. Lung Cancer 2005; 47: 165–72. PubMed

Zhou W, Heist RS, Liu G, et al. Smoking cessation before diagnosis and survival in early stage non-small cell lung cancer patients. Lung Cancer 2006; 53: 375–80. PubMed

Pirker R. Adjuvant chemotherapy of non-small cell lung cancer. Tanaffos 2012; 11: 12–17. PubMed PMC

Mason DP, Subramanian S, Nowicki ER, et al. Impact of smoking cessation before resection of lung cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database study. Ann Thorac Surg 2009; 88: 362–70. PubMed

Peppone LJ, Mustian KM, Morrow GR, et al. The effect of cigarette smoking on cancer treatment-related side effects. Oncologist 2011; 16: 1784–92. PubMed PMC

Graham K, Unger E. Overcoming tumor hypoxia as a barrier to radiotherapy, chemotherapy and immunotherapy in cancer treatment. Int J Nanomedicine 2018; 13: 6049–58. PubMed PMC

Browman GP, Wong G, Hodson I, et al. Influence of cigarette smoking on the efficacy of radiation therapy in head and neck cancer. N Engl J Med 1993; 328: 159–63. PubMed

Cadham CJ, Cao P, Jayasekera J, et al. Cost-effectiveness of smoking cessation interventions in the lung cancer screening setting: a simulation study. J Natl Cancer Inst 2021; 113: 1065–73. PubMed PMC

Lopez-Olivo MA, Maki KG, Choi NJ, et al. Patient adherence to screening for lung cancer in the US: a systematic review and meta-analysis. JAMA Network Open 2020; 3: e2025102. PubMed PMC

Clark MA, Gorelick JJ, Sicks JD, et al. The relations between false positive and negative screens and smoking cessation and relapse in the National Lung Screening Trial: implications for public health. Nicotine Tob Res 2016; 18: 17–24. PubMed PMC

Ward E, Jemal A, Cokkinides V, et al. Cancer disparities by race/ ethnicity and socioeconomic status. CA Cancer J Clin 2004; 54: 78–93. PubMed