Background: Smoking cessation has been associated with reduced lung cancer mortality. This study aimed to synthesize current evidence on the impact of quitting smoking at or around the time of diagnosis of lung cancer on survival, considering factors such as histological subtype, cancer stage, and cessation intervention. Methods: A systematic search was conducted in the Ovid-MEDLINE, Ovid-EMBASE, Cochrane Central Register of Controlled Trials, and KoreaMed databases up to September 2024. Randomized controlled trials and cohort studies enrolling adult current smokers with pathologically confirmed lung cancer and comparing smoking cessation at or around diagnosis with continued smoking, were included. The primary outcome was overall survival (minimum follow-up of 3 months). The included studies were critically appraised using the revised Risk of Bias for Nonrandomized Studies (RoBANS 2) tool and meta-analyzed. Results: A total of 25 cohort studies comprising 17,584 patients were reviewed. Quitting smoking at diagnosis was associated with a 26% reduction in mortality risk (adjusted HR [aHR] 0.74, 95% CI 0.68–0.81). In subgroup analyses, quitting smoking was associated with improved survival in both non-small cell lung cancer (aHR 0.73, 95% CI 0.64–0.83) and small cell lung cancer (aHR 0.61, 95% CI 0.51–0.72), with a more pronounced benefit among patients with early-stage disease (stage I–III or limited stage; aHR 0.64, 95% CI 0.56–0.74). Furthermore, active smoking cessation interventions were significantly associated with improved survival (aHR 0.55, 95% CI 0.35–0.88). Conclusions: The findings underscore the importance of encouraging smoking cessation at the time of lung cancer diagnosis as an integral part of patient management to improve survival outcomes.
背景：戒烟已被证实与降低肺癌死亡率相关。本研究旨在综合当前证据，探讨在肺癌确诊时或确诊前后戒烟对生存期的影响，并综合考虑组织学亚型、癌症分期及戒烟干预措施等因素。 方法：系统检索了截至2024年9月的Ovid-MEDLINE、Ovid-EMBASE、Cochrane对照试验中心注册库及KoreaMed数据库。纳入的研究包括随机对照试验及队列研究，研究对象为经病理确诊的成年当前吸烟肺癌患者，比较确诊时或确诊前后戒烟与持续吸烟的差异。主要结局指标为总生存期（最短随访时间3个月）。采用修订版非随机研究偏倚风险评估工具（RoBANS 2）对纳入研究进行严格评估，并进行荟萃分析。 结果：共纳入25项队列研究，涉及17,584例患者。确诊时戒烟与死亡风险降低26%相关（校正风险比[aHR] 0.74，95%置信区间[CI] 0.68–0.81）。亚组分析显示，戒烟与非小细胞肺癌（aHR 0.73，95% CI 0.64–0.83）和小细胞肺癌（aHR 0.61，95% CI 0.51–0.72）的生存期改善均相关，且在早期疾病患者（I–III期或局限期；aHR 0.64，95% CI 0.56–0.74）中获益更为显著。此外，积极的戒烟干预措施与生存期改善显著相关（aHR 0.55，95% CI 0.35–0.88）。 结论：研究结果强调了在肺癌确诊时鼓励戒烟作为患者管理的重要组成部分，对改善生存结局具有重要意义。
肿瘤(癌症)患者之家