Brendan T Heiden1, Daniel B Eaton2, Su-Hsin Chang3, Yan Yan3, Martin W Schoen4, Li-Shiun Chen5, Nina Smock6, Mayank R Patel2, Daniel Kreisel7, Ruben G Nava7, Bryan F Meyers8, Benjamin D Kozower8, Varun Puri7. 1. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO. Electronic address: bheiden@wustl.edu. 2. Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO. 3. Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO; Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO. 4. Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO; Division of Hematology and Medical Oncology, Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, MO. 5. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO; Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO. 6. Department of Psychiatry, Washington University School of Medicine, St. Louis, MO. 7. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO; Division of Research and Education, VA St. Louis Health Care System, St. Louis, MO. 8. Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO.
Abstract
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.
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.
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