Smoking history before surgery and prognosis in patients with stage IA non-small-cell lung cancer—a multicenter study

Kawai, Hiroki; Tada, Atsuhiko; Kawahara, Mutsuto; Nakai, Kaoru; Maeda, H; Saitou, Ryuusei; Iwami, Fumiyuki; Ishikawa, Kiyoshi; Fukai, Shimao; Komatsu, Hikotaro

doi:10.1016/j.lungcan.2004.12.006

Cited by 47 publications

(36 citation statements)

References 24 publications

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“…Percentages of adenocarcinoma in individual studies ranged from 17.3% to 100%. 51,66,67) Disease stages included varied from study to study; some studies analyzed only stage IA disease undergoing complete resection, 46,53,62,65) while some others included only unresectable stage IIIB and IV patients scheduled for chemotherapy or chemoradiotherapy. 56,59,75) Final statistical analyses used either univariate or multivariate analyses, or both.…”

Section: Resultsmentioning

confidence: 99%

“…Hsu et al 78) reported that median survival was the same for never-smoking women and never-smoking men with adenocarcinoma, suggesting that both smoking status and histologic type rather than gender decided survival. In several studies, 34,40,70) a significant survival advantage for women disappeared after statistically adjusting for smoking status, although in other studies 28,41,49,51,53,57,58,76,77) survival advantages for women persisted after adjustment for smoking. In our meta-analysis, which combined these conflicting studies, female gender still persisted as a favorable prognostic factor, independent of smoking status.…”

Section: Figmentioning

confidence: 94%

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Female Gender Is an Independent Prognostic Factor in Non-small-cell Lung Cancer: A Meta-analysis

Nakamura

Ando

Shinmyo

et al. 2011

Ann Thorac Cardiovasc Surg

120

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Purpose: It is not clear whether women with non-small-cell lung cancer (NSCLC) live significantly longer than men. Thus, we conducted a meta-analysis of published studies to quantitatively compare NSCLC survival data between genders. Materials and Methods: A MEDLINE Web search for computer-archived bibliographic data regarding overall survival differences between genders was performed. DerSimonian-Laird random effects analysis was used to estimate the pooled hazard ratio (HR). Results: We selected 39 articles as appropriate data sources, involving 86 800 patients including 32 701 women and 54 099 men. Combined HRs for women vs. men in studies using univariate and multivariate analyses respectively were 0.79 (p <0.0001) and 0.78 (p <0.0001). Pooled HRs for 3 study subgroups having (1) fewer than 30% stage I cases, (2) fewer than 50% adenocarcinoma cases, and (3) statistical adjustment for smoking status all indicated the survival advantage of women. Conclusion: This meta-analysis of published data concerning NSCLC patients indicated significantly better survival for women.

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Section: Resultsmentioning

confidence: 99%

Section: Figmentioning

confidence: 94%

Female Gender Is an Independent Prognostic Factor in Non-small-cell Lung Cancer: A Meta-analysis

Nakamura

Ando

Shinmyo

et al. 2011

Ann Thorac Cardiovasc Surg

120

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“…Whereas several studies report smoking to be a predictor of poor prognosis, [6][7][8][9][10][11][12] others have found no such association. [13][14][15][16][17][18][19] One study reported smoking as a negative prognostic factor only in men, 20 whereas another found an association only in women. 21 Even less is known about the survival of never smokers who undergo pulmonary resections with curative intent for NSCLC, with one recent study reporting a modest survival benefi t of never smokers only in stage I patients with adenocarcinoma.…”

Section: Discussionmentioning

confidence: 99%

Long-term Survival Outcomes by Smoking Status in Surgical and Nonsurgical Patients With Non-small Cell Lung Cancer

Meguid¹,

Hooker²,

Harris³

et al. 2010

Chest

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Lung cancer is the leading cause of cancer death in the United States. 1 Although it is well known that lung cancer is associated with tobacco use, it is also apparent that never smokers are susceptible to the disease. Comparisons of genetic and epigenetic aberrations in non-small cell lung cancer (NSCLC) among smokers and never smokers have revealed marked differences in tumor biology that have resulted in clinicopathologic distinctions between smokers and never smokers. Data have established that mutational differences in the active kinase domain of the epidermal growth factor receptor confer increased sensitivities of a subset of never smokers with lung cancer to tyrosine kinase inhibitors. 2,3 Less well established is the actual natural history of NSCLC in never smokers compared with smokers. Emerging tumor biology data, especially recent reports highlighting fewer genomic alterations in never smokers, such as gene Results: Never smokers were signifi cantly more likely than current smokers to be women ( P , .01), older ( P , .01), and to have adenocarcinoma ( P , .01) and bronchioloalveolar carcinoma ( P , .01). No statistically signifi cant differences existed in stage distribution at presentation for the analytic cohort ( P 5 .35) or for the subgroup undergoing surgery ( P 5 .24). The strongest risk factors of mortality among patients with NSCLC who underwent surgery were advanced stage (adjusted hazard ratio, 3.43; 95% CI, 2.32-5.07; P , .01) and elevated American Society of Anesthesiologists classifi cation (adjusted hazard ratio, 2.18; 95% CI, 1.40-3.40; P , .01). The minor trend toward an elevated risk of death on univariate analysis for current vs never smokers in the surgically treated group (hazard ratio, 1.20; 95% CI, 0.98-1.46; P 5 .07) was completely eliminated when the model was adjusted for covariates ( P 5 .97). Conclusions: Our fi ndings suggest that smoking status at time of lung cancer diagnosis has little impact on the long-term survival of patients with NSCLC, especially after curative surgery. Despite different etiologies between lung cancer in never and current smokers the prognosis is equally dismal.CHEST 2010; 138(3):500-509Abbreviations: aHR 5 adjusted hazard ratio; AJCC 5 American Joint Commission on Cancer; ASA 5 American Society of Anesthesiologists; BAC 5 bronchioloalveolar carcinoma; HR 5 hazard ratio; NSCLC 5 non-small cell lung cancer

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“…Factors including smoking history, serum level of carcinoembryonic antigen, and tumor size, as well as lymphatic and venous invasion have been identified as poor prognostic factors for lung adenocarcinoma. [8][9][10][11][12] Recently, a pathological entity called the micropapillary pattern has been reported to have worse outcomes in breast, 13 colon, 14 urinary tract, 15 ovary, 16 salivary gland, 17 and lung 18,19 cancer. The micropapillary pattern in lung adenocarcinoma is characterized by small papillary tufts lying in alveolar spaces or in spaces encased by connective tissues, with the tufts having no fibrovascular core, 18,19 and it has been reported as an important factor for poor prognosis.…”

Section: Introductionmentioning

confidence: 99%

Histopathological features and prognostic significance of the micropapillary pattern in lung adenocarcinoma

et al. 2008

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The micropapillary pattern is characterized by small papillary tufts with no fibrovascular core lying in spaces and has been reported as an aggressive variant of carcinoma in several organs. We investigated the histopathobiological properties of the micropapillary pattern with immunohistochemistry, serial sections, and electron microscopy in lung adenocarcinoma. We further analyzed its clinicopathological character and prognosis. The subjects included 383 adenocarcinoma cases, of which 184 (48%) were micropapillary patternpositive and 199 (52%) were micropapillary pattern-negative. On histology, micropapillary tufts seemed to float in the alveolar space or spaces encased by connective tissues, whereas serial sections revealed that most tufts had continuity with other tufts and even with the main tumor. Positive staining for the adhesion molecules E-cadherin and b-catenin suggested the preservation of tight adhesion, and electron microscopy showed the existence of intercellular junctions. Negative staining for laminin and loss of basement membrane as determined by electron microscopy suggest a loss of cell-matrix contact. Positive staining for Ki-67 indicates that cells constituting micropapillary tufts retained their proliferation potency. There were no CD34-positive cells in micropapillary tufts, and the loss of the vascular core was confirmed. In micropapillary pattern-positive cases, lymphatic invasion was identified significantly more frequently than in micropapillary pattern-negative cases (Po0.001), even at stageIA (without lymph node metastasis, N ¼ 197) (Po0.001). The 5-year and 10-year overall survival rates of the micropapillary pattern-positive stageIA group were 77.6 and 67.6%, respectively, which were significantly less than those of the micropapillary pattern-negative stageIA group (98.1 and 98.1%) (P ¼ 0.001). In conclusion, cells constituting the micropapillary pattern are likely to have acquired anchorage-independent growth and a potential for high malignancy.

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Smoking history before surgery and prognosis in patients with stage IA non-small-cell lung cancer—a multicenter study

Cited by 47 publications

References 24 publications

Female Gender Is an Independent Prognostic Factor in Non-small-cell Lung Cancer: A Meta-analysis

Female Gender Is an Independent Prognostic Factor in Non-small-cell Lung Cancer: A Meta-analysis

Long-term Survival Outcomes by Smoking Status in Surgical and Nonsurgical Patients With Non-small Cell Lung Cancer

Histopathological features and prognostic significance of the micropapillary pattern in lung adenocarcinoma

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