title: Effect of smoking on survival from non-small cell lung cancer: a retrospective Veterans' Affairs Central Cancer Registry (VACCR) cohort analysis.
abstract: Although a well-established risk factor for lung cancer, the impact of smoking on the survival of non-small cell lung cancer (NSCLC) is not well known. We performed a retrospective analysis of the Veteran's Affairs Comprehensive Cancer Registry of NSCLC patients. Smoking status was categorized as never smoker, past smoker and current smoker based on self-reported history. Multivariate analysis was performed to evaluate the impact of smoking on overall survival (OS) from NSCLC. The study population (n = 61,440) comprised predominantly of males (98 %) and Caucasians (81 %). The median age at diagnosis was 68 years (range 22-108 years). Current smokers were diagnosed with NSCLC at a younger age (65 years) compared to never smokers (71 years) and past smokers (72 years) (p < 0.001). On multivariate analysis, current smokers (n = 34,613) [Hazard ratio (HR) 1.059; 95 % confidence interval (CI) 1.012-1.108], but not past smokers (n = 23,864) (HR 1.008; 95 % CI 0.962-1.056), had worse OS for Stage III and IV NSCLC, compared to never smokers (n = 2,963). Smoking status was not prognostic in stages I and II NSCLC. Current smokers were diagnosed with NSCLC at a younger age than never smokers. Although current smoking was associated with worse prognosis, especially in stages III and IV, the impact of smoking status on OS was modest.
authors.affiliation: Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE, 68198-7680, USA.
authors.forename: Vijaya Raj
authors.initials: VR
authors.lastname: Bhatt
authors.forename: Rishi
authors.initials: R
authors.lastname: Batra
authors.forename: Peter T
authors.initials: PT
authors.lastname: Silberstein
authors.forename: Fausto R
authors.initials: FR
authors.lastname: Loberiza
authors.forename: Apar Kishor
authors.initials: AK
authors.lastname: Ganti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D055815:Young Adult