UICC World Cancer Congress 2006

Objective: Despite the indisputable link between smoking and the increased risk for lung cancer, the inclusion of this factor in prognostic survival analysis has been scarce. Important clinical questions regarding the smoking status in patients operated for NSCLC form the basis of this study: what is the prognostic benefit of having been a non-smoker or having stopped smoking prior to developing lung cancer and what is the prognostic benefit of smoking cessation at the time of diagnosis of lung cancer? Methods: Cigarette smoking status of 311 patients operated for non-small cell lung cancer by a single surgeon was determined based on two independent questionnaires taken prospectively prior to lung operation. A Cox multiple regression model was used to test the prognostic value of smoking status on survival together with other relevant clinicopathological factors. Results: 169 (54.3%) patients were current smokers, 25 (8.0%) non-smokers, 82 (26.4%) former smokers and 35 (11.3%) were recent quitters. For overall survival, older age (p=0.011), presence of lymph node metastases (p<0.001) and current smoking (p=0.001) were independent predictors of poor prognosis, while non-smokers (relative risk=0.447, 95% confidence interval=0.206-0.970, p=0.042), former smokers (relative risk=0.543, 95% confidence interval=0.350-0.843, p=0.006) and recent quitters (relative risk=0.340, 95% confidence interval=0.164-0.705, p=0.004) had a significant better prognosis compared to current smokers. Similar results were obtained for disease-free survival. These results indicate that smoking cessation is beneficial for lung cancer patients at any time point prior to lung operation and current smoking at the time of operation is associated with poor prognosis.