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Comprehensive analysis of clinical, radiological, pathological findings, and survival outcomes, in non-smoker non-small cell lung cancer patients
1Department of Chest Diseases, Hacettepe University Faculty of Medicine, Ankara, Turkiye
2Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkiye
3Department of Medical Oncology, Istinye University Faculty of Medicine, Liv Hospital, Ankara, Turkiye
Eurasian Journal of Pulmonology - DOI: 10.14744/ejp.2024.1013

Abstract


Background and Aim: Lung cancer in non-smokers exhibits distinct epidemiological and biological characteristics. Despite a global decline in cigarette consumption, the incidence of lung cancer in non-smokers is on the rise. Regrettably, screening programs often overlook these patients. This study seeks to explore the clinical, radiological, and pathological features, as well as survival results, among non-smoker patients with non-small cell lung cancer (NSCLC).

Methods: The study included 74 non-smoker patients among 315 diagnosed with NSCLC between January 2013 and May 2023. Patient characteristics, survival outcomes, and factors predicting overall survival (OS) were examined.

Results: The mean age at diagnosis was 57.6±13.3 years (range: 23-82) years, and 57 patients (77%) were female. Upon diagnosis, 90% of patients were symptomatic, and 69% were at stage 3 or 4. The median follow-up time was 3.7 years (0.2-8.9), and the 5-year progression-free survival (PFS) and OS rates were 20.7±4.8% and 36.2±6.3%, respectively. Median PFS was 1.6 years (%95CI: 1.16-2.04) and median OS was 4.04 years (%95CI: 3.16-4.93). In multivariate Cox regression analysis, stage 4 disease at diagnosis (HR: 3.656, p<0.001) and non-adenocarcinoma histology (HR: 2.896, p=0.019) were independent predictors of OS.

Conclusion: Approximately one-quarter of NSCLC patients are non-smokers, with the majority being women diagnosed with adenocarcinoma. Individuals are commonly diagnosed after symptoms begin, usually at an advanced or locally advanced stage. Stage IV disease at diagnosis and non-adenocarcinoma histology were independent predictors of worse prognosis. Since current screening studies have primarily targeted the smoking population, there is a pressing need for research to identify additional risk factors, especially for the inclusion of non-smokers in screening programs.