Effect of comorbidities on long-term outcomes after thoracoscopic surgery for stage I non-small cell lung cancer patients with chronic obstructive pulmonary disease

Abstract

Background:We assessed how the severity of chronic obstructive pulmonary disease (COPD) and other comorbidities affect long-term survival after thoracoscopic lung resection for c-stage I non-small cell lung cancer (NSCLC). Results: The cohort comprised 404 patients with NSCLC, of whom 133 were diagnosed with COPD (51 as GOLD 1, 79 as GOLD 2, and 3 as GOLD 3) and 271 were diagnosed without COPD. The 5-year overall survival (OS) rates were 86.0%, 80.2%, and 71.1% for the non-COPD, GOLD 1, and GOLD 2/3 groups, respectively (P=0.0221); the corresponding 5-year disease-specific survival (DSS) rates were 91.7%, 86.9%, and 85.1% (P=0.2136). Univariate analysis indicated that sex, smoking status, pathology, COPD severity, CCI, and pathological stage were associated with OS, and multivariate analysis confirmed the association with CCI and pathological stage. Postoperative complications were significantly more frequent in the GOLD 1 (21.5%) and GOLD 2/3 (26.8%) groups than in the non-COPD group (12.1%) (P=0.0040).Conclusions: Following thoracoscopic surgery (TS) for NSCLC, patients with COPD had a poorer OS than patients without COPD. However, the CCI and not the COPD severity was the independent prognostic factor for OS. Comorbidities adversely affected long-term survival of patients with stage I NSCLC and COPD after TS, and the same effect can be oncologically expected regardless of the COPD severity.Keywords: Non-small cell lung cancer (NSCLC); chronic obstructive pulmonary disease (COPD); Charlson comorbidity index (CCI); thoracoscopic surgery (TS)

Risk factors for post‐operative pulmonary complications in lung cancer patients after video‐assisted thoracoscopic lung resection: Results of the German Thorax Registry

“…We did not include the Charlson comorbidity index (CCI) in the German Thorax Registry. Although the CCI was described as a valid prognostic factor for the 5‐year overall survival of patients undergoing lung cancer resection, it did not reach significance compared to the ASA Score as a predictor of PPCs after thoracoscopic lobectomy . The Thoracoscore as well as the cardiopulmonary risk index were described as insufficient to predict PPCs or mortality after lung resection surgery …”

“…Although the CCI was described as a valid prognostic factor for the 5-year overall survival of patients undergoing lung cancer resection, it did not reach significance compared to the ASA Score as a predictor of PPCs after thoracoscopic lobectomy. [35][36][37] The Thoracoscore as well as the cardiopulmonary risk index were described as insufficient to predict PPCs or mortality after lung resection surgery. 38,39 Whereas patient-specific risk factors usually appear non-adjustable, data on procedural risk factors for PPCs are more valuable for clinicians due to the fact that these are modifiable parameters.…”

The impact of emphysema on surgical outcomes of early-stage lung cancer: a retrospective study

“…The postoperative complications graded according to the Clavien-Dindo classification in the present study showed that emphysema lung was closely associated with pneumonia and supraventricular tachycardia. Previous studies have suggested that postoperative pulmonary complications were linked to several preoperative variables including obesity [43], COPD [26, 44], smoking habit [43], and so on. Takahashi et al showed that emphysema based on high-resolution CT (HRCT) was independently associated with pulmonary complications after single lobectomy [45].…”

Endoscopic Technologies for Peripheral Pulmonary Lesions: From Diagnosis to Therapy

“…In addition, lung cancer patients, due to their age and exposure to risk factors such as cigarette smoking, are frequently affected by other diseases such as chronic obstructive pulmonary disease, heart failure, ischemic heart disease, arterial hypertension, atrial fibrillation, cerebrovascular disease, and peripheral vascular disease [ 143 , 144 ]. These pathologies may both exclude eligibility for surgery or worsen postoperative survival outcomes, a matter still neglected in the medical literature [ 145 , 146 ]. The only other option remaining with a radical intent is stereotaxic body radiation therapy, which, despite its effectiveness, bears significant adverse effects [ 147 , 148 , 149 , 150 ].…”