<p>Impact of Combined Chronic Obstructive Pulmonary Disease Status and Systemic Inflammation on Outcome of Advanced NSCLC: Multicenter Retrospective Cohort Study</p>

Abstract

Background In patients with non-small cell lung cancer (NSCLC), both chronic obstructive pulmonary disease (COPD) and systemic inflammatory biomarkers, such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR), have significant association with prognosis. NLR and PLR also predict mortality in patients with COPD alone. A combination of the two parameters may be helpful in a more individualized approach for predicting prognosis in NSCLC. Methods Medical records of patients with stage IIIB and IV NSCLC from January 2012 to January 2018 in seven university hospitals were reviewed. Patients were categorized into four subgroups based on pulmonary function test results and cutoffs for NLR or PLR. Results A total of 277 patients were evaluated and categorized into non-COPD and COPD groups; 194 patients were in the non-COPD group and 83 patients were in the COPD group. The non-COPD group showed significantly longer overall survival (OS) compared with the COPD group (P = 0.019). Median survival was significantly different between high/low PLR groups (P < 0.001), between high/low NLR groups (P = 0.001), and between high/low c-reactive protein (CRP) groups (P < 0.001). PLR, NLR and CRP showed significant correlations with each other. PLR showed a significant negative linear correlation with FVC (absolute) (r = −0.149, P = 0.015), FVC (%) (r = −0.192, P = 0.002), DLCO (absolute) (r = −0.271, P < 0.001), DLCO (%) (r = −0.139, P = 0.032), and NLR (r = 0.718, P < 0.001). In the multivariate analysis, the high PLR, COPD sub-group showed significantly higher risk for mortality (HR 2.066 (1.175–3.633), P = 0.012) compared with the low-PLR non-COPD group. However, COPD-NLR subtype was not an independent predictor for OS. Conclusion A combination of COPD status and PLR may be a cost-effective and readily available prognostic marker in patients with advanced NSCLC.

Impact of Chronic Obstruction Pulmonary Disease with Acute Exacerbation on Survival in Current-Smoking Patients with Advanced stages Lung Squamous Cell Carcinoma undergoing Concurrent Chemoradiotherapy

“…'s study showed high platelet-lymphocyte ratio, COPD group had signi cantly higher risk for mortality compared with the low-platelet-lymphocyte ratio non-COPD group. [43] There were no consistent treatments for advanced NSCLC in Lim' study. [43] In fact, there were different regimens of chemotherapy combined with RT for squamous cell carcinoma or adenocarcinoma according to NCCN guidelines.…”

“…[43] There were no consistent treatments for advanced NSCLC in Lim' study. [43] In fact, there were different regimens of chemotherapy combined with RT for squamous cell carcinoma or adenocarcinoma according to NCCN guidelines.…”

“…There were several small sample size, retrospective, inhomogeneous lung cancer types, different stages, and inconsistent treatments studies for the survival impact of COPD in treatments of lung cancers. [42][43][44][45] In the previous study, COPD is a risk factor for postoperative recurrence in non-small-cell lung cancer (NSCLC) patients, and moderate to severe COPD is an independent adverse prognostic factor for recurrence-free survival which is very different from our endpoint (overall survival). [44] A recent paper reports that Coexisting COPD has an effect on the survival of patients with small-cell lung cancer who are undergoing chemotherapy, but different from ours were lung squamous cell carcinoma (SCC) receiving standard CCRT.…”

“…[42] Lim et al have studied the impact of COPD status and systemic In ammation on outcome of advanced NSCLC with multicenter retrospective cohort study. [43] Lim et. al.…”

“…[15] There were no consistent pathologic types of lung cancer in the aforementioned studies. [42][43][44] Moreover, Zhai et al studied the impact of coexisting COPD on the survival of patients with early-stage NSCLC undergoing surgical resection, instead of CCRT for advanced lung SCC which the impact of coexisting COPD for the surgery-related toxicity or complications might be different from ours of CCRT (de nitive CCRT for clinical stage IIIA-IIIB lung SCC). [45] Taken together, this study is the rst to show that the frequency of hospitalization for COPDAE within 1 year before CCRT (similar to Global Initiative for Chronic Obstructive Lung Disease [GOLD] Classi cation 3-4) [10] is a signi cant risk factor for all-cause death and lung cancer death for the patients with lung SCC receiving de nitive CCRT.…”