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

Junjia Zhu, Steven Branstetter, Philip Lazarus and Joshua E. Muscat ()
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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

IJERPH, 2024, vol. 21, issue 4, 1-11

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.

Keywords: lung cancer; nicotine dependence; screening; survival; time to first cigarette; cancer stage (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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