New Research Highlights the Importance of Smoking Status in Lung Cancer Staging

A pioneering study conducted by the University of Kentucky Markey Cancer Center, led by Dr. Graham Warren and international collaborators, has shed light on the critical impact of smoking status on lung cancer prognosis. Published in the Journal of Thoracic Oncology on September 8, 2025, the research emphasizes that a patient's smoking history at the time of diagnosis significantly influences survival outcomes. Traditionally, lung cancer staging relies on tumor size, location, and metastasis; however, this new evidence suggests that smoking status should be integrated into the staging process. The comprehensive analysis of nearly 49,000 lung cancer patients across 25 countries revealed that current or former smokers have survival rates comparable to patients in a higher cancer stage who never smoked, with current smokers experiencing a 39% lower survival rate than never smokers, and former smokers 32% lower. Interestingly, smoking history had a more profound prognostic effect than some established factors like lymph node involvement, especially in early-stage disease. These findings underscore the urgency of integrating robust smoking cessation programs into cancer care, particularly in regions like Kentucky where smoking rates are high. A parallel study in JAMA Oncology demonstrated that quitting smoking within six months of diagnosis could extend median survival by approximately four years. Warren, now leading the TRUST initiative at Markey, emphasizes that addressing smoking is among the most effective strategies to improve patient outcomes, reducing treatment costs, and extending survival. The research team plans to advocate for incorporating smoking status into the next edition of the international lung cancer staging system, which could reshape diagnostic and treatment approaches worldwide.