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Peer-reviewedCC BY-NC-ND 4.0In Vivo

History of Smoking and Prognosis of Patients With Non-small Cell Lung Cancer

  • MARTIN SVATON1
  • PETR DOMECKY2
  • ONDREJ VENCLICEK3
  • JANA KREJCI4
  • MICHAL HRNCIARIK5
  • ONDREJ FISCHER6
  • MARIE DROSSLEROVA7
  • DANIEL HRICISAK8
  • KAREL ODRAZKA9
  • MILOSLAV MAREL10
10 affiliations
  1. 1Department of Pneumology and Phthisiology, University Hospital in Pilsen, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
  2. 2Department of Social and Clinical Pharmacy, Faculty of Pharmacy in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
  3. 3Department of Respiratory Diseases, Faculty of Medicine, Masaryk University and University Hospital, Brno, Czech Republic
  4. 4Department of Pneumology, Bulovka University Hospital and Third Faculty of Medicine, Charles University, Prague, Czech Republic
  5. 5Pulmonary Department, University Hospital Hradec Kralove and Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
  6. 6Department of Respiratory Medicine, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
  7. 7Department of Respiratory Medicine, Thomayer Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
  8. 8Department of Oncology, Liberec Regional Hospital, Liberec, Czech Republic
  9. 9Multiscan Oncological and Radiological Center, Pardubice, Czech Republic
  10. 10Department of Pneumology, Second Faculty of Medicine, Charles University, Motol University Hospital, Prague, Czech Republic
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Abstract

Background/Aim: Smoking is a known risk factor for the development of non-small-cell lung cancer (NSCLC). However, conflicting results are reported in the literature regarding the risk of smoking on the prognosis of patients with NSCLC. Moreover, these studies were often conducted before the era of personalized targeted therapy and immunotherapy, which can significantly improve the prognosis of patients. The aim of the present study was to evaluate the prognosis of patients with NSCLC in relation to their smoking history.

Patients and Methods: This retrospective multicentre study included all patients from the Czech LUCAS registry with baseline tumour characteristics. Overall survival was assessed using Kaplan-Meier estimates, with differences between groups evaluated by the log-rank test and multivariate Cox regression model, adjusting for covariates and stratifying by disease stage when proportional hazards assumptions were violated.

Results: A total of 3,372 patients were included. In the univariate model, non-smokers had a significantly better prognosis than former and current heavy smokers (with a history of ≥40 pack-years), hazard ratio=1.19 (95% confidence interval=1.01-1.42), p=0.043; and hazard ratio 1.19 (95% confidence interval=0.03-1.37), p=0.018, respectively. This relationship was not significant in the multivariate model. The absence of a prognostic significance of smoking at the time of NSCLC diagnosis was also demonstrated in a multivariate model both in patients with advanced disease treated with anticancer drugs and in patients who underwent surgery.

Conclusion: Although smoking/ex-smoking at the time of NSCLC diagnosis had a negative prognostic impact in univariate analysis, multivariate analysis did not demonstrate smoking itself as an independent prognostic factor for NSCLC. Therefore, other factors, including poorer performance status, likely contributed to the poorer outcome for smokers.

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Cite

BibTeXRIS
BibTeX
@article{svaton2026history,
  title = {{History of Smoking and Prognosis of Patients With Non-small Cell Lung Cancer}},
  author = {MARTIN SVATON and PETR DOMECKY and ONDREJ VENCLICEK and JANA KREJCI and MICHAL HRNCIARIK and ONDREJ FISCHER and MARIE DROSSLEROVA and DANIEL HRICISAK and KAREL ODRAZKA and MILOSLAV MAREL},
  journal = {In Vivo},
  year = {2026},
  month = oct,
  doi = {10.21873/invivo.14508},
  url = {https://doi.org/10.21873/invivo.14508},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - History of Smoking and Prognosis of Patients With Non-small Cell Lung Cancer
AU  - MARTIN SVATON
AU  - PETR DOMECKY
AU  - ONDREJ VENCLICEK
AU  - JANA KREJCI
AU  - MICHAL HRNCIARIK
AU  - ONDREJ FISCHER
AU  - MARIE DROSSLEROVA
AU  - DANIEL HRICISAK
AU  - KAREL ODRAZKA
AU  - MILOSLAV MAREL
PY  - 2026
DA  - 2026/10/29
JO  - In Vivo
DO  - 10.21873/invivo.14508
UR  - https://doi.org/10.21873/invivo.14508
AB  - Background/Aim: Smoking is a known risk factor for the development of non-small-cell lung cancer (NSCLC). However, conflicting results are reported in the literature regarding the risk of smoking on the prognosis of patients with NSCLC. Moreover, these studies were often conducted before the era of personalized targeted therapy and immunotherapy, which can significantly improve the prognosis of patients. The aim of the present study was to evaluate the prognosis of patients with NSCLC in relation to their smoking history.  Patients and Methods: This retrospective multicentre study included all patients from the Czech LUCAS registry with baseline tumour characteristics. Overall survival was assessed using Kaplan-Meier estimates, with differences between groups evaluated by the log-rank test and multivariate Cox regression model, adjusting for covariates and stratifying by disease stage when proportional hazards assumptions were violated.  Results: A total of 3,372 patients were included. In the univariate model, non-smokers had a significantly better prognosis than former and current heavy smokers (with a history of ≥40 pack-years), hazard ratio=1.19 (95% confidence interval=1.01-1.42), p=0.043; and hazard ratio 1.19 (95% confidence interval=0.03-1.37), p=0.018, respectively. This relationship was not significant in the multivariate model. The absence of a prognostic significance of smoking at the time of NSCLC diagnosis was also demonstrated in a multivariate model both in patients with advanced disease treated with anticancer drugs and in patients who underwent surgery.  Conclusion: Although smoking/ex-smoking at the time of NSCLC diagnosis had a negative prognostic impact in univariate analysis, multivariate analysis did not demonstrate smoking itself as an independent prognostic factor for NSCLC. Therefore, other factors, including poorer performance status, likely contributed to the poorer outcome for smokers.
SN  - 0258-851X
SN  - 1791-7549
ER  -