Prognostic Significance of Cigarette Smoking in Association with Histologic Subtypes of Resected Lung Adenocarcinoma

Abstract

Background Smokers with lung adenocarcinoma have a worse prognosis than those who have never smoked; the reasons for this are unclear. We aimed to elucidate the impact of smoking on patients’ prognosis and the association between smoking and clinicopathologic factors, particularly histologic subtypes. Methods We reviewed the records of 233 patients with pathologic stage T1-4N0-2M0 lung adenocarcinomas who underwent surgery between January 2004 and July 2015. The histologic subtypes of tumors were reassessed according to the 2015 World Health Organization classification. Results In total, 114 patients had a history of smoking. The overall survival probabilities differed between never-smokers and ever-smokers (80.8% and 65.1%, respectively; p=0.003). In multivariate analyses, the predominant histologic subtype was an independent poor prognostic factor. Smoking history and tumor size >3 cm were independent predictors of solid or micropapillary (SOL/MIP)-predominance in the logistic regression analysis. Smoking quantity (pack-years) in patients with SOL/MIP-predominant tumors was greater than in those with lepidic-predominant tumors (p=0.000). However, there was no significant difference in smoking quantity between patients with SOL/MIP-predominant tumors and those whose tumors had non-predominant SOL/MIP components (p=0.150). Conclusion Smoking was found to be closely associated with SOL/MIP-predominance in lung adenocarcinoma. Greater smoking quantity was related to the presence of a SOL/MIP component.