The Effect of COPD on Survival in Patients with Lung Cancer

Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer and may impact how patients’ cancer is managed. A study found that overall survival (OS) time does not differ between patients with stage I non-small cell lung cancer (NSCLC) with and without COPD, but patients with severe or very severe COPD may have a lower survival time compared with those with no, mild, or moderate disease. The results of the study were presented at the CHEST Annual Meeting 2020.

Patients with stage I NSCLC treated at the Cleveland Clinic health system between January 2006 and December 2012 were retrospectively reviewed. COPD was confirmed using spirometry or CT scan to identify emphysema. Global Initiative for Chronic Obstructive Lung Disease recommendations were used to determine COPD severity. Data collection included NSCLC presentation, evaluation, treatment, OS, and complications.

Of 610 patients with NSCLC, 341 (55%) had COPD; the mean age was 69.9 years, and the cohorts did not differ in baseline sex, body mass index, cardiovascular disease, diabetes, other chronic lung disease, and chronic kidney disease. A greater proportion of patients with COPD had squamous cell carcinoma (33.7% vs. 27.5%; P=0.0001) and an Eastern Cooperative Oncology Group performance status score ≥2 (20.8% vs. 11.8%; P=0.013). COPD patients were less likely to have adenocarcinoma (63.9% vs. 46.9%; P=0.0001).

Regarding treatment, patients with COPD were less likely to undergo lobectomy (62.1% vs. 72.4%; P=0.0779) but more likely to undergo radiation (42.7% vs. 24.3%; P<0.0001).

Postoperative cardiac arrhythmias were significantly more common in patients with COPD (10.6% vs. 2.6%; P=0.0016).

OS did not largely differ between patients with and without COPD (6.14 years vs. 7.08 years; P=0.1029). However, OS was poorer in patients with severe or very severe COPD compared with patients with mild or moderate disease (4.86 years vs. 6.95 years; P=0.0003).

“Lower OS time in those with stage I NSCLC and severe and very severe COPD should be considered when weighing the risks and benefits of evaluation and management decisions,” the study authors concluded.