Impact of Smoking on the Histological Subtype and Outcome of the Primary Lung Adenocarcinoma

  Objective  To explore the effect of smoking on the histological subtype and prognosis of patients with lung adenocarcinoma (LAC) in China.

  Methods  According to the new International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society(IASLC/ATS/ERS)classification, 266 donors with primary LAC were reclassified. The correlation between clinicopathological factors including smoking status and the histological subtype was analyzed, and survival analysis was used to analyze the prognosis of primary LAC.

  Results  There were four main histological subtypes including acinar predominant adenocarcinoma (APA) 30.1%, papillary predominant adenocarcinoma (PPA) 26.7%, solid predominant adenocarcinoma (SPA) 25.9%, and lepidic predominant adenocarcinoma (LPA) 11.7%.Smoking was associated with the histological subtype.The proportion of smokers was significantly higher than non-smokers in the SPA group, and the proportion of non-smokers was higher in other subtypes group. Cox regression model showed that the histological subtype and TNM stage were the independent predictors of prognostic in all patients.TNM stage was the predictor of postoperative survival in both smokers and non-smokers, and histological subtypes was the predictor only in smokers (β=0.898, RR=2.455). Compared with the non-SPA group, the prognosis of the SPA group was significantly worse.

  Conclusion  Smoking is associated with SPA subtype, which affect the prognosis of primary LAC.