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Background <p>Lung cancer is a leading cause of cancer-related mortality. Non-small cell lung cancer (NSCLC) comprises 85% of cases with rising incidence among never-smokers (NS). This study seeks to compare clinical, imaging, pathology, and outcomes between NS and ever-smokers (S) NSCLC patients to identify significant differences if any.</p> Methods <p>Retrospective cohort study of 155 NSCLC patients (88 S and 67 NS). The main predictor was smoking. Clinical, imaging, and pathology findings were evaluated at initial biopsy for staging. The primary outcome was all-cause mortality, and the secondary outcome was 12-month progression-free survival.</p> Results <p>Imaging: NS and S had similar nodule size (0.81), calcification (&gt; 0.99), and invasion of adjacent structures (&gt; 0.99) (<i>p</i> values). NS slightly trended to more commonly involve the RLL vs S the RUL (<i>p</i> = 0.11). NS had higher numbers of extrathoracic metastases at initial biopsy for staging (<i>p</i> = 0.055).</p> <p>Pathology: NS more commonly had adenocarcinoma compared to S, who had equal numbers of adenocarcinoma and squamous cell carcinoma (<i>p</i> = 0.001). Rates of lymphovascular and pleural invasion were similar (<i>p</i> = 0.84 and 0.28).</p> <p>Initial staging: NS were more often initially diagnosed with stage IV disease (<i>p</i> = 0.046), positive nodal disease (<i>p</i> = 0.002), and metastatic disease (<i>p</i> = 0.004).</p> <p>Outcomes: S had a non-significant trend toward worse 12-month progression-free survival (rate ratio = 1.31, <i>p</i> = 0.31; HR = 1.33, <i>p</i> = 0.28). NS and S had similar 1-year all-cause mortality (HR = 1.06, <i>p</i> = 0.90). S had nearly double the risk of all-cause mortality in 5&#xa0;years (HR = 1.73, <i>p</i> = 0.056) and 10&#xa0;years (HR = 1.77, <i>p</i> = 0.02). Median survival was 6.6&#xa0;years for NS and 3.9&#xa0;years for S, with NS surviving 2.7&#xa0;years longer on average (<i>p</i> = 0.045).</p> Conclusions <p>CT nodule features were similar in NS and S. NS more often had metastatic adenopathy, distant metastases, and stage IV disease at initial biopsy. Despite similar 12-month progression-free survival and 1-year all-cause mortality, S had nearly double the risk of mortality in the first 5 and 10&#xa0;years post-diagnosis.</p> Trial registration <p>Retrospectively registered.</p>

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Non-small cell lung cancer in ever-smokers vs never-smokers

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年1月5日

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  • Jeremy R. Burt,
  • Naim Qaqish,
  • Greg Stoddard,
  • Amani Jridi,
  • Parker Sage Anderson,
  • Lacey Woods,
  • Anna Newman,
  • Malorie R. Carter,
  • Reham Ellessy,
  • Jordan Chamberlin,
  • Ismail Kabakus

摘要

Background

Lung cancer is a leading cause of cancer-related mortality. Non-small cell lung cancer (NSCLC) comprises 85% of cases with rising incidence among never-smokers (NS). This study seeks to compare clinical, imaging, pathology, and outcomes between NS and ever-smokers (S) NSCLC patients to identify significant differences if any.

Methods

Retrospective cohort study of 155 NSCLC patients (88 S and 67 NS). The main predictor was smoking. Clinical, imaging, and pathology findings were evaluated at initial biopsy for staging. The primary outcome was all-cause mortality, and the secondary outcome was 12-month progression-free survival.

Results

Imaging: NS and S had similar nodule size (0.81), calcification (> 0.99), and invasion of adjacent structures (> 0.99) (p values). NS slightly trended to more commonly involve the RLL vs S the RUL (p = 0.11). NS had higher numbers of extrathoracic metastases at initial biopsy for staging (p = 0.055).

Pathology: NS more commonly had adenocarcinoma compared to S, who had equal numbers of adenocarcinoma and squamous cell carcinoma (p = 0.001). Rates of lymphovascular and pleural invasion were similar (p = 0.84 and 0.28).

Initial staging: NS were more often initially diagnosed with stage IV disease (p = 0.046), positive nodal disease (p = 0.002), and metastatic disease (p = 0.004).

Outcomes: S had a non-significant trend toward worse 12-month progression-free survival (rate ratio = 1.31, p = 0.31; HR = 1.33, p = 0.28). NS and S had similar 1-year all-cause mortality (HR = 1.06, p = 0.90). S had nearly double the risk of all-cause mortality in 5 years (HR = 1.73, p = 0.056) and 10 years (HR = 1.77, p = 0.02). Median survival was 6.6 years for NS and 3.9 years for S, with NS surviving 2.7 years longer on average (p = 0.045).

Conclusions

CT nodule features were similar in NS and S. NS more often had metastatic adenopathy, distant metastases, and stage IV disease at initial biopsy. Despite similar 12-month progression-free survival and 1-year all-cause mortality, S had nearly double the risk of mortality in the first 5 and 10 years post-diagnosis.

Trial registration

Retrospectively registered.