title: Smoking is a perioperative risk factor and prognostic factor for lung cancer surgery.
abstract: OBJECTIVE
  The aim of this study was to investigate the smoking status of lung cancer patients and to confirm the risk of smoking for patients undergoing lung cancer surgery.
  
  
  METHODS
  We conducted a retrospective study of patients undergoing lung cancer surgery. Between May 2004 and March 2013, 716 patients underwent lung cancer surgery at our institution. Based on smoking status, the patients were classified into 3 groups: nonsmoker, past smoker, and current smoker. Based on exclusion criteria, a final total of 670 patients were investigated for the association between smoking status and postoperative complications. In addition, we explored the effect of smoking on survival after surgery.
  
  
  RESULTS
  There were 254 non-smokers, 246 past smokers, and 170 current smokers. The percent of female patients, adenocarcinoma, and stage IA cancer was highest in the nonsmokers. Respiratory function was significantly impaired in past and current smokers. Respiratory and cardiac complications were found less frequently in non-smokers (11.4%) followed by 17.1% of past smokers and 21.2% of current smokers (p = 0.0226). Univariate analysis showed that smoking was a significantly poor prognostic factor for overall survival. The 5-year survival rates for non-smokers, past, and current smokers were 81.4, 65.4, and 68.8%, respectively (p = 0.0003).
  
  
  CONCLUSIONS
  Smokers with lung cancer tended to have advanced lung cancer, impaired pulmonary function, and high morbidity after lung cancer surgery. Although multivariate analysis did not show that smoking was associated with poor outcome, non-smokers had significantly better overall survival, even for patients with stage IA lung cancers.
authors.affiliation: Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, 1800 Oazaaoyagi, Yamagata, 990-2292, Japan, sshiono@ypch.gr.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shiono
authors.forename: Masato
authors.initials: M
authors.lastname: Katahira
authors.forename: Masami
authors.initials: M
authors.lastname: Abiko
authors.forename: Toru
authors.initials: T
authors.lastname: Sato
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D013510:Pulmonary Surgical Procedures; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology* / Q000503:physiopathology
references.citation: J Thorac Oncol. 2007 Aug;2(8):706-14
references.pmid: 17762336
references.citation: Ann Thorac Surg. 2006 Apr;81(4):1189-93
references.pmid: 16564239
references.citation: Chest. 2004 Jan;125(1):27-37
references.pmid: 14718417
references.citation: J Clin Oncol. 2014 Feb 20;32(6):564-70
references.pmid: 24419133
references.citation: J Clin Oncol. 1999 Jul;17(7):2086-91
references.pmid: 10561262
references.citation: J Thorac Oncol. 2011 Apr;6(4):735-42
references.pmid: 21258254
references.citation: J Thorac Oncol. 2010 May;5(5):620-30
references.pmid: 20354456
references.citation: Lung Cancer. 2013 Sep;81(3):480-486
references.pmid: 23896023
references.citation: J Thorac Cardiovasc Surg. 2014 Feb;147(2):738-44; Discussion 744-6
references.pmid: 24252944
references.citation: J Thorac Oncol. 2007 Jan;2(1):34-8
references.pmid: 17410007
references.citation: Chest. 2004 Aug;126(2):347-51
references.pmid: 15302716
references.citation: Chest. 2007 Jul;132(1):185-92
references.pmid: 17573517
references.citation: Lung Cancer. 2009 Nov;66(2):218-25
references.pmid: 19321223
references.citation: Gen Thorac Cardiovasc Surg. 2013 Oct;61(10):578-607
references.pmid: 23990117
references.citation: CA Cancer J Clin. 2011 Mar-Apr;61(2):69-90
references.pmid: 21296855
references.citation: Chest. 2013 May;143(5 Suppl):e437S-e454S
references.pmid: 23649451
references.citation: Asian Cardiovasc Thorac Ann. 2013 Jun;21(3):313-8
references.pmid: 24570498