Abstract A049: Is smoking prognostic for advanced metastatic pancreatic cancer (PC) patients undergoing treatment
Authors: Ramo Aula , Nasser Zeinab , Beidoun Mohamad , Abbad Baha' Mustafa , Abdel-Razeq Nayef Hikmat , Khan Gazala 
Published: November 2022

Abstract
Introduction: PC is the third leading cause of cancer-related death in the United States. Cigarette smoking is a known risk factor for PC. Furthermore, it has been evaluated as a possible prognostic marker and has been shown that increased number of pack years is associated with worsened overall survival in PC (Yuan et al). However, it has yet to be shown whether patients undergoing active treatment and are current smokers, are facing a worse prognosis. Our study aims to examine the effect of current smoking on survival outcomes of advanced/metastatic PC patients undergoing active treatment. Methods: This is a retrospective study. Patients diagnosed with advanced/metastatic pancreatic cancer at Henry Ford Health between January 2016 and January of 2021 were identified via chart review. Variables collected included age, gender, smoking status (subclassified as never smokers, former smokers, and active smokers), performance status (documented as Eastern Cooperative Oncology Group (ECOG), number of chemotherapy (CTX) lines, and survival status that is most recently documented by May 1st, 2002. Median survival time were calculated to present the survival time for which the proportion surviving reached 50 percent. Kaplan-Meier estimates were used to generate survival curves for each cohort. The log-rank test was performed to compare the survival distributions among smoking status. Cox model was fit to estimate the association between smoking behavior and overall survival, adjusted for demographics and cancer-related variables. CTX was treated as a time-dependent covariate. All statistical tests were 2-sided with an α (significance) level of 0.05. All data was analyzed using R version 4.1.2. Results: A total of 269 PC patients were included in the analysis. The mean age of the cohort was 66 years and 50.9% were males. The mortality rate (from time of diagnosis to May 1st, 2022 was about 89%. Around 8% of patients underwent surgery, 21% have taken radiation therapy, and only one patient did not undergo CTX. For smoking behavior, 46.1% were never smokers, 34.6% were former smokers, and 19.3% were current smokers. Looking at baseline characteristics, the mean age of active smokers were 4 to 5 years less than never/former smokers and the average ECOG score of non-smokers were 0.28 to 0.32 point less than former/active smokers. Median survival time for patients never smoking was 11.7 months, 8.9 months for former smokers, and 11.4 months for active smokers. The log-rank test did not show sufficient evidence of a difference in survival across patients’ smoking status. Conclusion: Active smoking status does not appear to influence overall survival in advanced/metastatic pancreatic cancer patients undergoing various chemotherapy treatments. This study was limited in its retrospective nature and a relatively small sample. Information regarding level of smoking (light smokers vs heavy smokers) was not readily available. The prognostic value of smoking in PC will need to be assessed prospectively.
Citation Format: Aula Ramo, Zeinab Nasser, Mohamad Beidoun, Baha' Mustafa Abbad, Nayef Hikmat Abdel-Razeq, Gazala Khan. Is smoking prognostic for advanced metastatic pancreatic cancer (PC) patients undergoing treatment [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A049.