The International Association for the Study of Lung Cancer Staging Project: The Impact of Smoking Status on Lung Cancer Staging in the Ninth Edition of the TNM Classification
- Lawson Eng 1, William K Evans 2, Megan Eisele 3, Katherine K Nishimura 3, Stephanie R Land 4, Ramon Rami-Porta 5, Carolyn M Dresler 6, Hisao Asamura 7, Joelle T Fathi 8, Kendra Lechtenberg 9, Valerie Rusch 10, Mahdi Sheikh 11, Murry W Wynes 9, Keelan Zius 9, Raymond U Osarogiagbon 12, Graham W Warren 13,
- Lawson Eng 1, William K Evans 2, Megan Eisele 3
- 1Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
- 2Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
- 3Cancer Research And Biostatistics (CRAB), Seattle, Washington.
- 4Tobacco Control Research Branch, National Cancer Institute Division of Cancer Control and Population Sciences, Rockville, Maryland.
- 5Department of Thoracic Surgery, Hospital Universitari Mutua Terrassa, University of Barcelona, Terrassa, Barcelona, Spain; Network of Centers for Biomedical Research in Respiratory Diseases (CIBERES) Lung Cancer Group, Terrassa, Barcelona, Spain.
- 6Action on Smoking and Health, Washington, District of Columbia.
- 7Division of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan.
- 8GO2 for Lung Cancer, Washington, District of Columbia; Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington.
- 9Scientific Affairs, International Association for the Study of Lung Cancer, Denver, Colorado.
- 10Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York.
- 11Genomic Epidemiology Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France.
- 12Multidisciplinary Thoracic Oncology Program, Baptist Cancer Center, Memphis, Tennessee.
- 13Department of Radiation Medicine, Markey Cancer Center, University of Kentucky, Lexington, Kentucky.
- 0Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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September 8, 2025
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View abstract on PubMed
Summary
This summary is machine-generated.Smoking significantly worsens lung cancer survival. Both current and former smokers have poorer overall survival (OS) compared to never smokers, with current smoking being the worst. Smoking status impacts prognosis more than anatomical staging.
Area Of Science
- Oncology
- Public Health
- Biostatistics
Background
- Cigarette smoking is a known detriment to lung cancer prognosis.
- Integrating smoking history into staging may enhance survival predictions.
Purpose Of The Study
- To investigate the association between smoking status and overall survival in lung cancer patients.
- To determine if smoking status is a more significant prognostic factor than anatomical staging.
Main Methods
- Utilized the International Association for the Study of Lung Cancer (IASLC) NSCLC database (9th edition).
- Employed Kaplan-Meier plots and multivariate Cox regression models.
- Conducted subgroup analyses and recursive partitioning analysis to assess smoking's prognostic impact relative to staging factors.
Main Results
- Analyzed 48,531 patients: 26% current, 41% former, 34% never smokers.
- Current (aHR=1.39) and former (aHR=1.32) smokers had significantly worse overall survival (OS) than never smokers.
- Smoking status demonstrated a prognostic impact comparable to or exceeding anatomical staging (e.g., early-stage smoking vs. N0/N1 status).
Conclusions
- Smoking status is a critical prognostic factor in lung cancer.
- Smoking's prognostic impact may surpass that of anatomical staging alone.
- Future IASLC staging editions (e.g., 10th edition) will explore combining smoking status with TNM classification.
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