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Association between duration of smoking abstinence before non-small-cell lung cancer diagnosis and survival: a retrospective, pooled analysis of cohort studies

Fares, Aline F
Autor Fares, Aline F 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
Li, Yao
Autor Li, Yao Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
Jiang, Mei
Autor Jiang, Mei 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, First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
Brown, M Catherine
Autor Brown, M Catherine Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
Lam, Andrew C L
Autor Lam, Andrew C L Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
Aggarwal, Reenika
Autor Aggarwal, Reenika Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
Schmid, Sabine
Autor Schmid, Sabine Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada Universitätsklinik für Medizinische Onkologie, Inselspital Bern, Bern, Switzerland
Leighl, Natasha B
Autor Leighl, Natasha B Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
Shepherd, Frances A
Autor Shepherd, Frances A Princess Margaret Cancer Centre and University Health Network, University of Toronto, Toronto, ON, Canada
Wang, Zhichao
Autor Wang, Zhichao 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

The Lancet. Public health. 2023 ; 8 (9) : e691-e700. [pub] -

Lancet Public Health
ISSN 2468-2667
Medvik
Zdroj

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.

MeSH
kohortové studie MeSH
kouření epidemiologie MeSH
lidé MeSH
nádory plic * diagnóza MeSH
nemalobuněčný karcinom plic * diagnóza MeSH
retrospektivní studie MeSH
Check Tag
lidé MeSH
mužské pohlaví MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
práce podpořená grantem MeSH
Research Support, N.I.H., Extramural MeSH

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