Impact of Chronic Obstructive Pulmonary Disease on the Mortality of Patients with Non–Small-Cell Lung Cancer

Lee, Seung Jun; Lee, Jun Young; Park, Young Sik; Lee, Chang‐Hoon; Lee, Sang‐Min; Yim, Jae Joon; Yoo, Chul‐Gyu; Han, Sung Koo; Kim, Young Whan

doi:10.1097/jto.0000000000000158

Cited by 51 publications

(73 citation statements)

References 28 publications

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“…Although some argue that competing causes of death might dilute the mortality gains of screening smokers with COPD (34), the data do not bear this out (33). In all three studies that address this issue, after stratifying by the presence or absence of COPD on presurgery spirometry, comparable 5-year survival outcomes were found after surgical removal of early-stage NSCLC (35)(36)(37). If the differences in stage shift we found between COPD and no COPD were translated directly to mortality reduction, with no effect from competing causes of death or perioperative death from COPD, we estimate that the mortality reduction would be nearly twofold greater in those with COPD than in those with no COPD (66 and 34%, respectively).…”

Section: Discussionmentioning

confidence: 55%

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

Young

Duan

Chiles

et al. 2015

Am J Respir Crit Care Med

122

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Rationale: Annual computed tomography (CT) is now widely recommended for lung cancer screening in the United States, although concerns remain regarding the potential harms, including those from overdiagnosis.Objectives: To examine the effect of airflow limitation on overdiagnosis by comparing lung cancer incidence, histology, and stage shift in a subgroup of the National Lung Screening Trial (NLST). Methods:In an NLST subgroup (n = 18,714), screening participants were randomized to annual computed tomography (CT, n = 9,357) or chest radiograph (n = 9,357) screening and monitored for a mean of 6.1 years. After baseline prebronchodilator spirometry, to identify the presence of airflow limitation, 18,475 subjects (99%) were assigned as having chronic obstructive pulmonary disease (COPD) or no COPD. Lung cancer prevalence, incidence, histology, and stage shift were compared after stratification by COPD.Measurements and Main Results: For screening participants with spirometric COPD (n = 6,436), there was a twofold increase in lung cancer incidence (incident rate ratio, 2.15; P , 0.001) and, when compared according to screening arm, no excess lung cancers and comparable histology. Compared with chest radiography, there was also a trend favoring reduced late-stage and increased early-stage cancers in the CT arm (P = 0.054). For those with normal baseline spirometry (n = 12,039), we found an excess of lung cancers during screening in the CT arm, almost exclusively early-stage adenocarcinomarelated cancers (histology shift and overdiagnosis). After correction for these excess cancers, stage shift was marginal (P = 0.077).Conclusions: In the CT arm of the NLST-ACRIN (American College of Radiology Imaging Network) cohort, COPD status was associated with a doubling of lung cancer incidence, no apparent overdiagnosis, and a more favorable stage shift.

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Section: Discussionmentioning

confidence: 55%

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

Young

Duan

Chiles

et al. 2015

Am J Respir Crit Care Med

122

View full text Add to dashboard Cite

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“…Most studies found that COPD exerted an unfavorable effect on lung cancer prognosis [78, 110, 111], while others did not [112, 113]. Two recent meta-analyses indicated COPD as an adverse prognostic predictor, but the results suffered from a high level of heterogeneity between studies [114, 115].…”

Section: Prognosis Of Lung Cancer With Copdmentioning

confidence: 99%

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

et al. 2017

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Chronic obstructive pulmonary disease (COPD) and lung cancer are devastating pulmonary diseases that commonly coexist and present a number of clinical challenges. COPD confers a higher risk for lung cancer development, but available chemopreventive measures remain rudimentary. Current studies have shown a marked benefit of cancer screening in the COPD population, although challenges remain, including the common underdiagnosis of COPD. COPD-associated lung cancer presents distinct clinical features. Treatment for lung cancer coexisting with COPD is challenging as COPD may increase postoperative morbidities and decrease survival. In this review, we outline current progress in the understanding of the clinical association between COPD and lung cancer, and suggest possible cancer prevention strategies in this patient population.

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“…Improving our understandings of these associations has crucial public health implications, since the incidences of COPD and lung cancer have been steadily increasing worldwide. Some studies have suggested that lung cancer patients with COPD had poorer prognosis than those without, whilst other studies did not find differences in survival . Arca et al .…”

Section: Introductionmentioning

confidence: 98%

Impact of COPD and emphysema on survival of patients with lung cancer: A meta‐analysis of observational studies

et al. 2015

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Both COPD and emphysema are associated with an increased incidence of lung cancer, but the impacts of these comorbidities on lung cancer prognosis are still unclear. Herein, we conducted a meta-analysis to clarify whether the presence of these comorbidities indicates poor survival in patients with lung cancer. A comprehensive search was conducted using PubMed, Embase, Web of Science, ASCO Abstracts and Cochrane library for articles published before 1 June 2015. Papers referenced by the obtained articles were also reviewed. Main outcomes were overall survival (OS) and disease-free survival (DFS) in patients with lung cancer. Pooled hazard ratio (HR) and 95% confidence intervals (CIs) were calculated using random-effects models. Subgroup and sensitivity analyses were also conducted. Of 58 full texts reviewed, 26 met our inclusion criteria that were derived from 21 and seven studies examining the impacts of COPD and emphysema on survival of lung cancer, respectively. Metaanalyses revealed that concomitant COPD was associated with poorer OS (HR, 1.17; 95% CI: 1.10-1.25, n = 20), which was independent of tumour staging, diagnostic criteria of COPD or location, and DFS (HR, 1.52; 95% CI: 1.04-2.23, n = 6) with high heterogeneity (I 2 = 78%). The presence of emphysema in patients with lung cancer predicted worse OS (HR, 1.66; 95% CI: 1.25-2.22, n = 7), but not poorer DFS. The presence of COPD and emphysema are robust predictors of poor survival in patients with lung cancer. Early detection of these diseases should be taken into account for lung cancer surveillance and management.

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Impact of Chronic Obstructive Pulmonary Disease on the Mortality of Patients with Non–Small-Cell Lung Cancer

Abstract: COPD frequently and subliminally coexists with NSCLC. Although differences in clinical characteristic did exist, there was no impact of COPD on the mortality of patients with NSCLC with a positive smoking history in this study.

Cited by 51 publications

References 28 publications

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective

Impact of COPD and emphysema on survival of patients with lung cancer: A meta‐analysis of observational studies

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