1. Background
Retrospective studies suggest that non-smokers may have better outcomes after treatment for lung cancer but little prospective data exists.
2. Aims
We aimed to use a prospective database to establish outcomes for a cohort of patients treated with chemoradiotherapy (CRT) for Stage III non-small-cell lung cancer (NSCLC).
3. Methods
The AURORA database includes all clinical, treatment, and outcome details for patients with lung cancer treated at the Peter MacCallum Cancer Centre. We used Kaplan-Meier statistics to establish progression-free survival (PFS) and overall survival (OS) for a cohort treated between 2012 and 2022, divided according to pre-treatment smoking status.
4. Results
265 patients were included and median OS was 2 years (95% CI 1.8, 2.8). 25 were never smokers, 179 former smokers, and 61 current smokers. Median OS was 5.5 years for never smokers (95% CI 2.1, not reached), 2.0 years for former smokers (95% CI 1.5, 2.8), and 1.8 years (95% CI 1.3, 2.7) for current smokers. PFS was 1.8 years for never smokers (95% CI 0.8, 5.5) vs 1.4 years (95% CI 1.1, 1.8) for both former and current smokers. HR for death was 2.4 (95% CI 1.3-4.5) for former vs never smokers and 2.9 (95% CI 1.5, 5.6) for current vs never smokers. Actionable mutations were present in more never smokers (14/25) than former (9/179) or current smokers (3/61). However, neither this nor the use of tyrosine kinase inhibitor (TKI) was associated with superior survival in this cohort however - HR 0.7 (95% CI 0.4, 1.3)
5. Conclusions
Patients who have never smoked have superior survival after chemoradiotherapy for stage III NSCLC than those who previously smoked or those who continue to do so. This appears not to be solely driven by the presence of actionable tumour mutations or the use of TKIs.