TY - JOUR
T1 - Association between duration of smoking abstinence before non-small-cell lung cancer diagnosis and survival
T2 - a retrospective, pooled analysis of cohort studies
AU - Fares, Aline F.
AU - Li, Yao
AU - Jiang, Mei
AU - Brown, M. Catherine
AU - Lam, Andrew C.L.
AU - Aggarwal, Reenika
AU - Schmid, Sabine
AU - Leighl, Natasha B.
AU - Shepherd, Frances A.
AU - Wang, Zhichao
AU - Diao, Nancy
AU - Wenzlaff, Angela S.
AU - Xie, Juntao
AU - Kohno, Takashi
AU - Caporaso, Neil E.
AU - Harris, Curtis
AU - Ma, Hongxia
AU - Barnett, Matthew J.
AU - Leal, Leticia Ferro
AU - Fernandez-Tardon, G.
AU - Pérez-Ríos, Mónica
AU - Davies, Michael P.A.
AU - Taylor, Fiona
AU - Schöttker, Ben
AU - Brennan, Paul
AU - Zaridze, David
AU - Holcatova, Ivana
AU - Lissowska, Jolanta
AU - Świątkowska, Beata
AU - Mates, Dana
AU - Savic, Milan
AU - Brenner, Hermann
AU - Andrew, Angeline
AU - Cox, Angela
AU - Field, John K.
AU - Ruano-Ravina, Alberto
AU - Shete, Sanjay S.
AU - Tardon, Adonina
AU - Wang, Ying
AU - Le Marchand, Loic
AU - Reis, Rui Manuel
AU - Schabath, Matthew B.
AU - Chen, Chu
AU - Shen, Hongbing
AU - Ryan, Brid M.
AU - Landi, Maria Teresa
AU - Shiraishi, Kouya
AU - Zhang, Jie
AU - Schwartz, Ann G.
AU - Tsao, Ming S.
AU - Christiani, David C.
AU - Yang, Ping
AU - Hung, Rayjean J.
AU - Xu, Wei
AU - Liu, Geoffrey
N1 - Publisher Copyright:
© 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license
PY - 2023/9
Y1 - 2023/9
N2 - Background: The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. Methods: In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. Findings: Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1–3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87–0·97), patients with 3–5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83–0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87–0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81–0·93). Results were consistent across age, sex, histology, and disease-stage distributions. Interpretation: In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. Funding: The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.
AB - Background: The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival. Methods: In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival. Findings: Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1–3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87–0·97), patients with 3–5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83–0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87–0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81–0·93). Results were consistent across age, sex, histology, and disease-stage distributions. Interpretation: In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time. Funding: The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.
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U2 - 10.1016/S2468-2667(23)00131-7
DO - 10.1016/S2468-2667(23)00131-7
M3 - Article
C2 - 37633678
AN - SCOPUS:85168742159
SN - 2468-2667
VL - 8
SP - e691-e700
JO - The Lancet Public Health
JF - The Lancet Public Health
IS - 9
ER -