Background

Smoking at the time of surgical treatment for lung cancer increases the risk for perioperative morbidity and mortality. The prevalence of persistent smoking in the postoperative period and its association with long-term oncologic outcomes are poorly described.

Research Question

What is the relationship between persistent smoking and long-term outcomes in early-stage lung cancer after surgical treatment?

Study Design and Methods

We performed a retrospective cohort study using a uniquely compiled Veterans Health Administration dataset of patients with clinical stage I non-small cell lung cancer (NSCLC) undergoing surgical treatment between 2006 and 2016. We defined persistent smoking as individuals who continued smoking 1 year after surgery and characterized the relationship between persistent smoking and disease-free survival and overall survival.

Results

This study included 7,489 patients undergoing surgical treatment for clinical stage I NSCLC. Of 4,562 patients (60.9%) who were smoking at the time of surgery, 2,648 patients (58.0%) continued to smoke at 1 year after surgery. Among 2,927 patients (39.1%) who were not smoking at the time of surgical treatment, 573 (19.6%) relapsed and were smoking at 1 year after surgery. Persistent smoking at 1 year after surgery was associated with significantly shorter overall survival (adjusted hazard ration [aHR], 1.291; 95% CI, 1.197-1.392; P < .001). However, persistent smoking was not associated with inferior disease-free survival (aHR, 0.989; 95% CI, 0.884-1.106; P = .84).

Interpretation

Persistent smoking after surgery for stage I NSCLC is common and is associated with inferior overall survival. Providers should continue to assess smoking habits in the postoperative period given its disproportionate impact on long-term outcomes after potentially curative treatment for early-stage lung cancer.

中文翻译：

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手术后持续吸烟对 I 期非小细胞肺癌切除术后长期结果的影响

 背景

肺癌手术治疗时吸烟会增加围手术期发病率和死亡率的风险。术后期间持续吸烟的患病率及其与长期肿瘤学结果的关系尚不清楚。

 研究问题

持续吸烟与早期肺癌手术治疗后的长期结果之间有什么关系？

 研究设计和方法

我们使用退伍军人健康管理局独特编制的数据集进行了一项回顾性队列研究，该数据集包含 2006 年至 2016 年间接受手术治疗的临床 I 期非小细胞肺癌 (NSCLC) 患者。我们将持续吸烟定义为术后 1 年后继续吸烟的个体并描述了持续吸烟与无病生存率和总生存率之间的关系。

 结果

这项研究包括 7,489 名接受手术治疗的临床 I 期 NSCLC 患者。在手术时吸烟的 4,562 名患者（60.9%）中，2,648 名患者（58.0%）在术后 1 年继续吸烟。在手术治疗时不吸烟的 2,927 名患者 (39.1%) 中，573 名 (19.6%) 患者在术后 1 年复发并吸烟。术后 1 年持续吸烟与总生存期显着缩短相关（调整后风险比 [aHR]，1.291；95% CI，1.197-1.392； P < .001）。然而，持续吸烟与较差的无病生存率无关（aHR，0.989；95% CI，0.884-1.106； P = .84）。

 解释

I 期 NSCLC 手术后持续吸烟很常见，并且与较差的总体生存率相关。鉴于吸烟习惯对早期肺癌潜在治愈性治疗后的长期结果产生不成比例的影响，医疗服务提供者应继续评估术后期间的吸烟习惯。