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Of all smoking metrics, 20 pack-year history was the strongest predictor of both OS (HR 2.24, 95% CI 1.19-4.2 and DFS (HR 1.67, 95% CI 1.04-2.66) on univariable and multivariable analysis after adjusting for age, overall stage, and comorbidities. Patients with 20 pack-year smoking history were also more likely to have recurrence (HR 1.59, 95% CI 0.95-2.67) after adjusting for overall stage. Heavier smoking 20 pack-years was the strongest smoking metric associated with 2-times worse survival and recurrence. Our findings sugge
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