Commentary: Where there is no smoke, but fire

Central MessageSmoking status may portend a different tumor biology in NSCLC.See Article page 1903. Smoking NSCLC. See Non–small cell lung cancer (NSCLC) remains major public health problem, accounting for 25% of all cancer-related deaths.1Siegel R.L. Miller K.D. Jemal A. Cancer statistics, 2018.CA J Clin. 2018; 68: 7-30Crossref PubMed Scopus (5336) Google Scholar Our knowledge the epidemiology and NSCLC is constantly expanding; however, since Dr Luther L. Terry, MD, released first report Surgeon General's Advisory Committee on Health,2National Center Chronic Disease Prevention Health Promotion (US)Office Health. The Consequences Smoking—50 Years Progress: A Report General. Centers Control (US), Atlanta (GA)2014https://www.ncbi.nlm.nih.gov/books/NBK179276/Google role tobacco abuse as primary driver disease process unchanged. Despite this, never smokers also develop NSCLC—which represents similar but distinct entity that deserves its own characterization and, perhaps, treatment.3Bryant Cerfolio R.J. Differences epidemiology, histology, survival between cigarette never-smokers who non–small cancer.Chest. 2007; 132: 185-192Abstract Full Text PDF (122) In this issue Journal, Tang colleagues4Tang Ahmad U. Toth A.J. Bourdakis N. Raja S. Raymond D.P. et al.Non–small ever-smokers: it same disease?.J Thorac Cardiovasc Surg. 2021; 161: 1903-1917.e9Abstract (4) present their experiences treating at high-volume academic center, comparing outcomes postresection 172 1376 ever-smokers. epidemiologic data cohort showed what we have known to be true from previous observational studies5Subramanian J. Velcheti V. Gao F. Govindan R. Presentation stage-specific lifelong with (NSCLC).J Oncol. 2: 827-830Abstract (53) Scholar: were more likely women, lower lobe–predominant disease, adenocarcinoma histopathologic subtype when compared ever-smoker counterparts. Perhaps most interesting finding lies comparison matched pairs 2 groups, where 5-year stage 1 was substantially better (96%) than ever-smokers (78%). However, fared significantly worse ever-smokers, 54% versus 78% These results differ reports demonstrated stages never- ever-smokers.5Subramanian suggest tumors grow smaller larger, they becomes disproportionally aggressive counterparts possibly resulting underlying molecular mechanisms. Although manuscript does not account potential mechanism finding, do know show subset mutations therapeutic targets then smoking counterparts.6Pao W. Zakowski M. Doherty Politi K. Sarkaria I. al.EGF receptor gene are common cancers “never smokers” associated sensitivity gefitinib erlotinib.Proc Natl Acad Sci U S 2004; 101: 13306-13311Crossref (3750) Scholar,7Dutu T. Michiels Fouret P. Penault-Llorca Validire Benhamou al.Differential expression biomarkers adenocarcinoma: comparative study never-smokers.Ann 2005; 16: 1906-1914Abstract (51) unclear time whether these findings will change clinical practice, reasonable look ahead possibility separate staging required given behavior, or clinicians should larger smokers. colleagues provide an baseline which further explore differences This suggests one day using identify those risk rapid progression personalization treatment Is disease?The Journal Thoracic Cardiovascular SurgeryVol. 161Issue 6PreviewTo investigate presentation, pathology, after resection Full-Text