Time to first cigarette and its impact on lung tumorigenesis

Time to first cigarette (TTFC) in the morning has been identified as the best indicator of nicotine dependence and is associated with lung cancer risk beyond other measures of tobacco smoking. Using deep whole genome sequencing of 218 lung cancers from smokers, we show that TTFC is the strongest marker of tobacco smoking mutagenicity, with impact on lung tumor mutational burden, mutational signatures, intratumor heterogeneity, KRAS mutations and overall survival. These results pave the way for using TTFC as an easily measurable marker of lung tumorigenesis, with plausible therapeutic and prognostic implications.