Pack-years of cigarette smoking as a prognostic factor in patients with stage IIIB/ IV nonsmall cell lung cancer Journal Article


Authors: Janjigian, Y. Y.; Mcdonnell, K.; Kris, M. G.; Shen, R.; Sima, C. S.; Bach, P. B.; Rizvi, N. A.; Riely, G. J.
Article Title: Pack-years of cigarette smoking as a prognostic factor in patients with stage IIIB/ IV nonsmall cell lung cancer
Abstract: BACKGROUND: This study was undertaken to characterize the relation between the survival of patients with stage IIIB/IV nonsmall cell lung cancer (NSCLC) and pack-years of cigarette smoking (graded according to the American Joint Committee on Cancer staging system). METHODS: Data were analyzed from patients with stage IIIB/IV NSCLC who had completed a prospective smoking questionnaire. The impact of pack-years of cigarette smoking, age, sex, Karnofsky performance status (KPS), and the presence of weight loss >5% was evaluated on overall survival using univariate and multivariate analyses. RESULTS: Smoking history and clinical data were available for 2010 patients with stage IIIB/IV NSCLC (1004 women and 1006 men). Approximately 70% of patients (1409 patients) had smoked >15 pack-years, 13% (270) were former and current smokers who had smoked ≤15 pack-years, and 16% (331) were never-smokers (<100 lifetime cigarettes). Never-smokers had a longer median survival compared with former or current smokers (17.8 months vs 11.3 months; log-rank P < .001). Among smokers, patients with a ≤15 pack-year history of smoking had a longer median survival than patients who had smoked >15 pack-years (14.6 months vs 10.8 months; log-rank P = .03). As the number of pack-years increased, the median overall survival decreased (log-rank P < .001). Multivariate analysis indicated that a history of smoking was an independent prognostic factor (hazard ratio, 1.36; P < .001). CONCLUSIONS: More cigarette smoking, measured in pack-years, was associated with decreased survival after a diagnosis of stage IIIB/IV NSCLC. Trials assessing survival in patients with stage IIIB/IV NSCLC should report a detailed cigarette smoking history for all patients. © 2009 American Cancer Society.
Keywords: survival; adult; cancer survival; treatment outcome; aged; aged, 80 and over; middle aged; survival analysis; major clinical study; overall survival; cigarette smoking; advanced cancer; neoplasm staging; lung non small cell cancer; carcinoma, non-small-cell lung; lung neoplasms; weight reduction; smoking; dose-response relationship, drug; questionnaire; prognostic factor; cigarettes; nonsmall cell lung cancer; pack-years; smoking history
Journal Title: Cancer
Volume: 116
Issue: 3
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 2010-02-01
Start Page: 670
End Page: 675
Language: English
DOI: 10.1002/cncr.24813
PUBMED: 20029977
PROVIDER: scopus
PMCID: PMC2815173
DOI/URL:
Notes: --- - "Cited By (since 1996): 2" - "Export Date: 20 April 2011" - "CODEN: CANCA" - "Source: Scopus"
Altmetric Score
MSK Authors
  1. Camelia S Sima
    204 Sima
  2. Ronglai Shen
    129 Shen
  3. Naiyer A Rizvi
    157 Rizvi
  4. Yelena Yuriy Janjigian
    148 Janjigian
  5. Gregory J Riely
    350 Riely
  6. Peter Bach
    202 Bach
  7. Mark Kris
    612 Kris