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Löfling L, Karimi A, Sandin F, Bahmanyar S, Kieler H, Lambe M, Lamberg K, Wagenius G. Clinical characteristics and survival in non-small cell lung cancer patients by smoking history: a population-based cohort study. Acta Oncol 2019; 58:1618-1627. [PMID: 31373239 DOI: 10.1080/0284186x.2019.1638521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Introduction: Approximately, 10-15% of lung cancer patients have never smoked. Previous epidemiological studies on non-tobacco associated lung cancer have been hampered by selected data from a small number of hospitals or limited numbers of patients. By use of data from large population-based registers with national coverage, this study aims to compare characteristics and survival of patients with non-small cell lung cancer (NSCLC) with different smoking histories.Methods: Swedish national population-based registers were used to retrieve data on patients diagnosed with primary NSCLC between 2002 and 2016. The Kaplan-Meier method and Cox proportional hazard models were used to estimate overall survival and lung cancer-specific survival by smoking history.Results: In total, 41,262 patients with NSCLC were included. Of those, 4624 (11%) had never smoked. Never-smokers were more often women and older compared to ever smokers (current and former). Adenocarcinoma was proportionally more common in never-smokers (77%) compared to current (52%) and former smokers (57%). Stage IV disease was more common in never-smokers (57%) than in current (48%) and former smokers (48%). Epidermal growth factor receptor mutation was observed more in never-smokers (37%) compared to current (5%) and former smokers (9%). Both lung cancer-specific and overall survival were higher for never-smokers compared to current smokers.Conclusions: The observed differences in characteristics between never-smokers and smokers, and the higher survival in never-smokers compared to smokers from this large population-based study provide further evidence that lung cancer in never-smokers is clinically different to tobacco-associated lung cancer. The findings from this study emphasise the need for an improved understanding of genetics, pathogenesis, mechanisms and progression of non-tobacco associated lung cancer that may help prevent lung cancer or identify individually targeted treatments.
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Affiliation(s)
- Lukas Löfling
- Department of Medicine – Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, T2 Karolinska University Hospital, Solna, Sweden
| | - Annette Karimi
- Department of Medical Science, Uppsala University Hospital, Uppsala, Sweden
| | | | - Shahram Bahmanyar
- Department of Medicine – Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, T2 Karolinska University Hospital, Solna, Sweden
| | - Helle Kieler
- Department of Medicine – Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, T2 Karolinska University Hospital, Solna, Sweden
- Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Mats Lambe
- Regional Cancer Centre, Uppsala-Örebro, Uppsala, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Kristina Lamberg
- Department of Medical Science, Uppsala University Hospital, Uppsala, Sweden
| | - Gunnar Wagenius
- Department of Oncology, Karolinska University Hospital, Solna, Sweden
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