# Cigarette Smoking and Survival of Patients with Non-Melanoma Skin Cancer: A Systematic Literature Review and Meta-Analysis

## TL;DR

This study finds that smoking worsens survival in non-melanoma skin cancer patients, suggesting the need for smoking cessation counseling.

## Contribution

The study is the first meta-analysis to systematically evaluate the prognostic impact of smoking on non-melanoma skin cancer survival.

## Key findings

- Current or ever smoking is associated with worse overall survival in non-melanoma skin cancer patients.
- Smoking quantity (cigarettes per day or pack-years) is linked to poorer survival outcomes.
- Smoking cessation counseling should be integrated into routine care for these patients.

## Abstract

There is still limited evidence on whether cigarette smoking may affect the prognosis of patients with non-melanoma skin cancer (NMSC). Here, we conducted a systematic review and meta-analysis of published reports in Pubmed and Embase to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. The search was updated to February 2025. Based on five eligible articles published between 2015 and 2022, we found that the overall survival in patients with NMSC is negatively affected by current or ever smoking, as well as by the number of cigarettes smoked per day and the number of pack-years smoked in one’s lifetime. These results indicate that cigarette smoking is a negative prognostic factor in this patient population and underscore the importance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC.

Background: Non-melanoma skin cancer (NMSC) is the most frequent cancer in fair-skinned populations and represents a growing public health concern due to its impact in terms of morbidity and treatment costs. While some meta-analyses have investigated cigarette smoking as a risk factor for NMSC, less is known about its prognostic implications in patients with NMSC. This systematic review and meta-analysis aims to fill this gap by assessing the association between smoking habits and survival in patients with NMSC. Methods: A systematic search was conducted in PubMed and EMBASE up to 25 February 2025, to identify prospective studies of patients with histologically confirmed NMSC that evaluated the association between smoking habits and survival. Study-specific hazard ratios (HRs) and corresponding 95% confidence intervals (CIs) were pooled using random effects meta-analysis models. Results: A total of five studies published between 2015 and 2022 were included. The meta-analysis revealed that being a current or ever smoker at diagnosis was associated with a worse overall survival (summary HR 2.42, 95% CI 1.91–3.06). A similar result was observed when smoking exposure was assessed in terms of pack-years or number of cigarettes per day (summary HR 2.44, 95% CI 2.02–2.93). Conclusions: Our findings indicate that cigarette smoking is a negative prognostic factor in these patients, despite the generally excellent prognosis of NMSC. It is reasonable to assume that this unfavourable effect is largely due to the increased risk of developing other life-threatening conditions, in which smoking plays a causal role. These results underscore the clinical relevance of systematically integrating smoking cessation counselling into the routine management of patients with NMSC.