title: Difference in survival and prognostic factors between smokers and never-smokers with advanced non-small-cell lung cancer.
abstract: BACKGROUND
  Our aims were to investigate whether the association between smoking and survival is significant when adjusted for prognostic factors including use of epidermal growth factor tyrosine kinase inhibitors and the Glasgow Prognostic Score, an established score for inflammation, and to explore prognostic factors.
  
  
  METHODS
  We analyzed 244 patients with stage IIIB or IV non-small-cell lung cancer in a registry, including only chemotherapy-receiving outpatients with performance status zero.
  
  
  RESULTS
  Of 244 patients, 170 had died and the median follow-up time for the 74 surviving patients was 12.0 months. In multivariate Cox regression, smoker (hazard ratio compared to never-smoker: 1.67, P < 0.01), stage IV (hazard ratio compared to IIIB: 1.72, P < 0.01), and elevated C-reactive protein level (hazard ratio per 1 mg/dL increase: 1.08, P < 0.01) were significantly associated with shorter survival. The association between survival and smoking was significant, even after adjustment for the Glasgow Prognostic Score and regimens of chemotherapy (hazard ratio: 1.72, P = 0.02). In never-smokers, increased neutrophils were a major determinant of shorter survival and the interaction test between smoking and neutrophils was significant (hazard ratio per 1,000/mm(3) increase for smokers: 1.01; hazard ratio per 1,000/mm(3) increase for never-smokers: 1.44, P for interaction <0.01).
  
  
  CONCLUSIONS
  Known factors including treatment response or inflammatory process are not responsible for the fact that advanced non-small-cell lung cancer patients without any history of smoking have better survival than those who have smoked.
authors.affiliation: Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. shiro@kuhp.kyoto-u.ac.jp
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Yanagihara
authors.forename: Satoshi
authors.initials: S
authors.lastname: Tamaru
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kitano
authors.forename: Masanori
authors.initials: M
authors.lastname: Fukushima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D004815:Epidermal Growth Factor / Q000378:metabolism; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009504:Neutrophils / Q000378:metabolism / Q000473:pathology; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage; D012907:Smoking / Q000009:adverse effects / Q000401:mortality*; D016896:Treatment Outcome
chemical_list: D047428:Protein Kinase Inhibitors; D004815:Epidermal Growth Factor
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