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Surgical Outcomes in Non-Smoking Lung Cancer Patients
R. A. Meguid, C. M. Hooker, L. Xu, J. T. Sherwood, M. Sussman, S. C. Yang, M. V. Brock. Johns Hopkins University School of Medicine, Baltimore, MD,
BACKGROUND:
Currently, outcomes of non-smokers with non-small cell lung cancer (NSCLC) who undergo surgery are poorly characterized. We compared surgical outcomes of non-smokers and smokers with NSCLC diagnosed at our institution over the past 30 years.
METHODS:
This is a single institution retrospective study of all NSCLC patients from 1976-2006. In the surgery group, only patients who underwent surgery with curative intent were considered.
RESULTS:
The study population had 7455 patients, of which 813 (11%) were non-smokers. The majority of non-smokers were female (420/813, 52% vs. 2353/6642, 35%; p<0.01) with a median age significantly higher than female-smokers (65yrs vs. 62yrs, p<0.01). Similarly, more female non-smokers had bronchioalveolar cancer (BAC) compared to male non-smokers, female smokers and male smokers, respectively (40/420, 9.5% vs. 18/393, 4.6%; 89/2317, 3.8%; 92/4221, 2.2%;p<0.01). There was no difference, however, in the proportion of non-smokers or smokers who underwent surgical resection (244/813, 30% vs. 2082/6642, 31%, p=0.4). In addition, there were no differences in procedure type (p=0.2) or stage distribution of patients undergoing surgery in the 2 groups (p=0.3). The 5-year survival between non-smokers and smokers after curative surgery was not different (46.8% vs. 42.5%, p=0.25). Although females had a better overall survival than males after surgery (47% vs. 40.1%, p<0.001), there was no difference between non-smoking and smoking patients of the same gender. Those non-smokers with the best survival after surgery were females with BAC. There was a small, but not statistically significant, difference in the 5-year survival between female non-smokers and smokers with BAC (61.4% vs. 56.5%, p= 0.12).
CONCLUSIONS:
Surprisingly, smoking status has little impact on the long-term survival of patients with NSCLC after curative surgery. Although the most favorable outcome in non-smokers was in females with BAC, this was not statistically different than female smokers with the same histology. Despite different apparent etiologies between lung cancer in smoking and non-smoking patients, the prognosis is equally dismal.
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