Postdiagnosis Smoking Cessation and Reduced Risk for Lung Cancer Progression and Mortality

A Prospective Cohort Study

診斷后戒煙可降低肺癌進(jìn)展和死亡率

一項(xiàng)前瞻性隊(duì)列研究

Background:

Lung cancer is the leading cause of cancer death worldwide, and about one half of patients with lung cancer are active smokers at diagnosis.

Objective:

To determine whether quitting smoking after diagnosis of lung cancer affects the risk for disease progression and mortality.

Design:

Prospective study of patients with non–small cell lung cancer (NSCLC) who were recruited between 2007 and 2016 and followed annually through 2020.

Setting:

N.N. Blokhin National Medical Research Center of Oncology and City Clinical Oncological Hospital No. 1, Moscow, Russia.

Patients:

517 current smokers who were diagnosed with early-stage (IA-IIIA) NSCLC.

Measurements:

Probabilities of overall survival, progression-free survival, and lung cancer–specific mortality and hazard ratios (HRs) for all-cause and cancer-specific mortality.

Results:

During an average of 7 years of follow-up, 327 (63.2%) deaths, 273 (52.8%) cancer-specific deaths, and 172 (33.7%) cases of tumor progression (local recurrence or metastasis) were recorded. The adjusted median overall survival time was 21.6 months higher among patients who had quit smoking than those who continued smoking (6.6 vs. 4.8 years, respectively; P = 0.001). Higher 5-year overall survival (60.6% vs. 48.6%; P = 0.001) and progression-free survival (54.4% vs. 43.8%; P = 0.004) were observed among patients who quit than those who continued smoking. After adjustments, smoking cessation remained associated with decreased risk for all-cause mortality (HR, 0.67 [95% CI, 0.53 to 0.85]), cancer-specific mortality (HR, 0.75 [CI, 0.58 to 0.98]), and disease progression (HR, 0.70 [CI, 0.56 to 0.89]). （1）Similar effects were observed among mild to moderate and heavy smokers and patients with earlier and later cancer stages.

Limitation:

（2）Exposure measurements were based on self-reported questionnaires.

Conclusion:

Smoking cessation after diagnosis materially improved overall and progression-free survival among current smokers with early-stage lung cancer.

在輕中度、重度吸煙者和早期晚期癌癥階段相同的影響被觀察到谷羞。

局限性：暴露測(cè)量基于自我報(bào)道問(wèn)卷。

（醫(yī)咖會(huì)解讀）

include excluded

Smoker patients with early-stage(I-IIIA) non-small cell lung cancer who were recruited to a large multicentric prospective study of lung cancer survival in Russia were assessed for eligibility to participate in this study(n=722).

Excluded because:

Were followed passively(from death and cancer registries/hospital records)(n=190).

Were followed actively(patients/relatives were contacted),but information on postdiagnosis smoking could not be obtained(n=15).

Smoker patients who were actively followed to collect data on postdiagnosis smoking status were included in this study (n=517).

Continued smoking(n=297),lost to follow-up(n=0),intermittent smoking(n=0).analyzed(n=297),excluded(n=0).

quit smoking(n=220),lost to follow-up(n=0),relapsed smoking (n=8).analyzed (n=220),excluded (n=0).

baseline

Table1:baselilne demographinc and clinical characteristics and postenrollment treatments.

Participants,gender,education,median BMI,chronic diseases,regular alcohol drinking,

Median cumulation cigarettes smoked,pack-years.

Histology:squamous cell careinoma;adenocarcinoma;neuroendocrine tumors

Surgery;chemotheraphy;radiation therapy;

survival

Table2：estimates of survival rates among patients with early-stage non-small cell lung cancer who quit smoking versus those who continued smoking after diagnosis.

(1)Adjusted estimates of overall survival

Median survival time.y

Probability of survival at 3 y

Probability of survival at 5 y

(2)Adjusted estimates of progression-free survival

Median progression-free survival,y

Probability of progression-free survival at 3 y

Probability of progression-free survival at 5 y

(3)Adjusted estimates of lung cancer-specific mortality

Median time to lung cancer-specific mortality

Probability of lung cancer-specific mortality at 3 y

Probability of lung cancer-specific mortality at 5 y

association

Table3:association between quitting smoking postdiagnosis and outcomes patients with early-stage non-small cell lung cancer.

(1).all-cause mortality:adjusted hazard ratio

(2)disease progression(tumor recurrence or death)

(3)adjusted estimates of lung cancer-specific mortality.

Note:estimates are derived feom adjust time-dependent models.

被納入大型多中心前瞻性（俄羅斯肺癌存活率）研究的早期非小細(xì)胞肺癌吸煙患者被評(píng)估參與本次研究的資格。

排除原因：

被動(dòng)隨訪（來(lái)自死亡和癌癥登記中心\醫(yī)院記錄）（n=190）.

積極隨訪（病人/被聯(lián)系家屬），但是診斷后的吸煙情況無(wú)法獲得弱恒。（n=5）.

積極隨訪收集（在診斷后吸煙情況）數(shù)據(jù)的吸煙患者被納入研究中（n=517）.

繼續(xù)吸煙297人弟翘，失訪0人，間歇性吸煙0人田晚，分析人群297人，排除0人国葬。

停止吸煙220人贤徒，失訪0人，反復(fù)吸煙8人汇四，分析人群220人接奈，排除0人。

1.什么是無(wú)進(jìn)展生存率通孽？

就是疾病沒(méi)有任何進(jìn)一步發(fā)展序宦，癌癥無(wú)進(jìn)展一般判斷：影像學(xué)和病人癥狀。

表1：基線人口學(xué)背苦，臨床特征互捌，入組后治療

表2：評(píng)估生存率

（1）.調(diào)整后總生存率估計(jì)

（2）．調(diào)整后無(wú)進(jìn)展生存率估計(jì)

（3）.調(diào)整后因肺癌特異性死亡估計(jì)

含義理解：“無(wú)進(jìn)展”表示癌癥的前期，沒(méi)有惡化行剂；“肺癌特異性死亡”秕噪，在癌癥進(jìn)展過(guò)程中，會(huì)因?yàn)橐鹌渌l(fā)疾病厚宰，或因癌細(xì)胞擴(kuò)展導(dǎo)致死亡等腌巾，“癌癥特異性死亡”是其中一種死亡方式。而“總生存期”（也稱為“全因死亡率“）包含了癌癥所有的階段，所有的死亡方式澈蝙。

從數(shù)據(jù)上來(lái)看吓坚，“癌癥特異性死亡”的存活期要比總生存期的存活期要長(zhǎng)，表明在癌癥發(fā)展過(guò)程中引起的其他并發(fā)癥死亡灯荧，嚴(yán)重縮短了患者存活時(shí)間礁击。

表3：戒煙與患者結(jié)局相關(guān)性

全因死亡率

疾病過(guò)程中（癌癥復(fù)發(fā)或死亡）

肺癌特異性死亡

備注：估計(jì)值來(lái)自于調(diào)整時(shí)間相關(guān)模型。

積累詞匯：

Passively：消極的

Intermittent漏麦；間斷的

Relapsed客税；反復(fù)的

Chronic：慢性的

Cumulation，累計(jì)

cigarettes 撕贞，煙草

pack-years：按年打包

Histology:組織學(xué)

squamous cell careinoma;鱗狀細(xì)胞癌

adenocarcinoma;腺癌

neuroendocrine tumors：神經(jīng)內(nèi)分泌癌

chemotheraphy;化學(xué)治療

radiation therapy;放射治療

postenrollment treatment:滾進(jìn)來(lái)治療更耻，入組后治療

hazard=risk

recurrence,復(fù)發(fā)

be derived from,來(lái)自于

cessation=stop