吸烟戒断持续时间与非小细胞肺癌（NSCLC）诊断前的生存率关联对肺癌筛查中的公共卫生宣传具有影响。我们旨在评估吸烟戒断持续时间是否与NSCLC诊断前的生存率改善相关。本回顾性的合并分析入选了26个参与国际肺癌联盟（COS-ILCCO）临床结果研究的研究队列，其中23个由23家医院管理。这中间有16个（62%）来自北美，6个（23%）来自欧洲，3个（12%）来自亚洲，1个（4%）来自南美。参与者诊断时间从1983年6月1日至2019年12月31日。符合条件的患者需要在NSCLC诊断前有吸烟数据，临床数据在诊断时获取以大部分由患者问卷完成，并且包括从病历记录中检索出的临床信息。利用国际肺癌联盟数据库中各项个体数据生成Kaplan-Meier曲线和多因素Cox模型（即调整后的危险比[aHR]）。我们通过测量从诊断日期至最后随访日期或任何原因导致死亡的时间来估计全因死亡和NSCLC特异性生存情况。在COS-ILCCO数据库中的42,087名NSCLC患者中，男性占21,893名（52.0%），女性占20,194名（48.0%），我们排除了4,474名（10.6%）缺失数据的患者。与目前吸烟者（37,613名中的15,036名[40.0%]）相比，有1-3年吸烟戒断史（2890名[7.7%]）的患者的全因生存风险比（aHR）为0.92（95% CI 0.87-0.97），有3-5年吸烟戒断史（1114名[3.0%]）的患者的全因生存风险比为0.90（0.83-0.97），有5年以上吸烟戒断史（10,841名[28.8%]）的患者的全因生存风险比为0.90（0.87-0.93）。在戒烟的9,727名患者中，有4,301名（44%）NSCLC特异性生存率改善，并在超过5年的戒烟历程中具有显著性（aHR 0.87，95% CI 0.81-0.93）。这些结果在年龄、性别、组织学和疾病分期分布方面的一致性。在这项跨亚洲、欧洲、北美和南美的大型合并分析中，与诊断时间仅为1年的NSCLC患者相比，全因生存率在终止吸烟时间较短的患者中有所改善。这些发现表明，即使在较晚的肺癌筛查时发现NSCLC，戒烟仍然可以改善全因生存率。这些发现也支持随时实施公共卫生戒烟策略。Alan B Brown主席，Posluns家族基金，Lusi Wong基金和Princess Margaret Cancer Foundation提供支持。版权所有 © 2023 作者。由Elsevier Ltd.出版。本文采用CC BY-NC-ND 4.0版权协议。由Elsevier Ltd.出版。保留所有权利。

The association between duration of smoking abstinence before non-small-cell lung cancer (NSCLC) diagnosis and subsequent survival can influence public health messaging delivered in lung-cancer screening. We aimed to assess whether the duration of smoking abstinence before diagnosis of NSCLC is associated with improved survival.In this retrospective, pooled analysis of cohort studies, we used 26 cohorts participating in Clinical Outcomes Studies of the International Lung Cancer Consortium (COS-ILCCO) at 23 hospitals. 16 (62%) were from North America, six (23%) were from Europe, three (12%) were from Asia, and one (4%) was from South America. Patients enrolled were diagnosed between June 1, 1983, and Dec 31, 2019. Eligible patients had smoking data before NSCLC diagnosis, epidemiological data at diagnosis (obtained largely from patient questionnaires), and clinical information (retrieved from medical records). Kaplan-Meier curves and multivariable Cox models (ie, adjusted hazard ratios [aHRs]) were generated with individual, harmonised patient data from the consortium database. We estimated overall survival for all causes, measured in years from diagnosis date until the date of the last follow-up or death due to any cause and NSCLC-specific survival.Of 42 087 patients with NSCLC in the COS-ILCCO database, 21 893 (52·0%) of whom were male and 20 194 (48·0%) of whom were female, we excluded 4474 (10·6%) with missing data. Compared with current smokers (15 036 [40·0%] of 37 613), patients with 1-3 years of smoking abstinence before NSCLC diagnosis (2890 [7·7%]) had an overall survival aHR of 0·92 (95% CI 0·87-0·97), patients with 3-5 years of smoking abstinence (1114 [3·0%]) had an overall survival aHR of 0·90 (0·83-0·97), and patients with more than 5 years of smoking abstinence (10 841 [28·8%]) had an overall survival aHR of 0·90 (0·87-0·93). Improved NSCLC-specific survival was observed in 4301 (44%) of 9727 patients who had quit cigarette smoking and was significant at abstinence durations of more than 5 years (aHR 0·87, 95% CI 0·81-0·93). Results were consistent across age, sex, histology, and disease-stage distributions.In this large, pooled analysis of cohort studies across Asia, Europe, North America, and South America, overall survival was improved in patients with NSCLC whose duration of smoking abstinence before diagnosis was as short as 1 year. These findings suggest that quitting smoking can improve overall survival, even if NSCLC is diagnosed at a later lung-cancer screening visit. These findings also support the implementation of public health smoking cessation strategies at any time.The Alan B Brown Chair, The Posluns Family Fund, The Lusi Wong Fund, and the Princess Margaret Cancer Foundation.Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.