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Smoking, Lung Cancer Stage, and Prognostic Factors—Findings from the National Lung Screening Trial

Author

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  • Junjia Zhu

    (Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA)

  • Steven Branstetter

    (Department of Biobehavioral Heath, Penn State University, University Park, PA 16802, USA)

  • Philip Lazarus

    (Department of Pharmaceutical Sciences, Washington State University, Spokane, WA 99202, USA)

  • Joshua E. Muscat

    (Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA)

Abstract

Background: Low-dose computed tomography (LDCT) increases the early detection of lung cancer. Identifying modifiable behaviors that may affect tumor progression in LDCT-detected patients increases the likelihood of long-term survival and a good quality of life. Methods: We examined cigarette smoking behaviors on lung cancer stage, progression, and survival in 299 ever-smoking patients with low-dose CT-detected tumors from the National Lung Screening Trial. Univariate and multivariate Cox models were used to estimate the hazard ratio (HR) for smoking variables on survival time. Results: Current vs. former smokers and early morning smokers (≤5 min after waking, i.e., time to first cigarette (TTFC) ≤ 5 min) had more advanced-stage lung cancer. The adjusted HR for current vs. former smokers was 1.3 (95% confidence interval [CI] 0.911–1.98, p = 0.136) for overall survival (OS) and 1.3 (0.893–1.87, p = 0.1736) for progression-free survival (PFS). The univariate hazard ratios for TTFC ≤ 5 min vs. >5 min were 1.56 (1.1–2.2, p = 0.013) for OS and 1.53 (1.1–2.12, p = 0.01) for PFS. Among current smokers, the corresponding HRs for early TTFC were 1.78 (1.16–2.74, p = 0.0088) and 1.95 (1.29–2.95, p = 0.0016) for OS and PFS, respectively. In causal mediation analysis, the TTFC effect on survival time was mediated entirely through lung cancer stage. Conclusion: The current findings indicate smoking behaviors at diagnosis may affect lung cancer stage and prognosis.

Suggested Citation

  • Junjia Zhu & Steven Branstetter & Philip Lazarus & Joshua E. Muscat, 2024. "Smoking, Lung Cancer Stage, and Prognostic Factors—Findings from the National Lung Screening Trial," IJERPH, MDPI, vol. 21(4), pages 1-11, March.
    • Handle: RePEc:gam:jijerp:v:21:y:2024:i:4:p:400-:d:1363868
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    References listed on IDEAS

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    1. Tingley, Dustin & Yamamoto, Teppei & Hirose, Kentaro & Keele, Luke & Imai, Kosuke, 2014. "mediation: R Package for Causal Mediation Analysis," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 59(i05).
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