The Impact of Coexisting COPD on Survival of Patients With Early-Stage Non-small Cell Lung Cancer Undergoing Surgical Resection
The Impact of Coexisting COPD on Survival of Patients With Early-Stage Non-small Cell Lung Cancer Undergoing Surgical Resection
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DOI：
10.1378/chest.13-1176
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发表时间：
2014-02-01
期刊：
影响因子：
9.6
通讯作者：
Christiani, David C.
中科院分区：
文献类型：
--
作者：
Zhai, Rihong;Yu, Xiaojin;Christiani, David C.
背景：COPD是公认的肺癌的危险因素，但关于共存COPD与肺癌结局相关的研究有限。我们评估COPD对早期非小细胞肺癌（NSCLC）患者总生存期（OS）和无进展生存期（PFS）的影响。方法：回顾性分析902例手术切除的早期（IA-IIB期）NSCLC患者。自我报告，医生诊断的COPD与NSCLC生存率的关联进行了评估，使用对数秩和考克斯回归模型，调整年龄，性别，BMI，吸烟，阶段，和性能status.Results：在这一队列的NSCLC患者中，330例医生诊断的COPD，572例没有COPD。COPD患者的5年OS（54.4%）显著低于非COPD患者（69.0%）（P = 0.0002）。COPD患者和非COPD患者的5年PFS率分别为50.1%和60.6%（P = 0.007）。与非COPD患者相比，COPD患者的OS（校正风险比[HRadj]= 1.41，P = 0.002）和PFS（HRadj = 1.67，P = 0.003）恶化风险增加。COPD和更差的生存结局之间的关联更强的男性和鳞状细胞癌（SCC）。结论：共存的COPD与早期NSCLC患者更差的生存结局相关，特别是男性和SCC。
Background: COPD is a recognized risk factor for lung cancer, but studies of coexisting COPD in relation to lung cancer outcomes are limited. We assessed the impact of COPD on overall survival (OS) and progression-free survival (PFS) in patients with early-stage non-small cell lung cancer (NSCLC).Methods: Patients (N = 902) with early-stage (stage IA-IIB) NSCLC treated with surgical resection were retrospectively analyzed. The association of self-reported, physician-diagnosed COPD with survivals of NSCLC was assessed using the log-rank and Cox regression models, adjusting for age, sex, BMI, smoking, stages, and performance status.Results: Among this cohort of patients with NSCLC, 330 cases had physician-diagnosed COPD, and 572 did not have COPD. The 5-year OS in patients with COPD (54.4%) was significantly lower (P = .0002) than that in patients without COPD (69.0%). The 5-year PFS rates for patients with COPD and without COPD were 50.1% and 60.6%, respectively (P = .007). Compared with patients without COPD, patients with COPD had increased risk of worse OS (adjusted hazard ratio [HRadj] = 1.41, P = .002) and PFS (HRadj = 1.67, P = .003). The associations between COPD and worse survival outcomes were stronger in men and in squamous cell carcinoma (SCC).Conclusions: Coexisting COPD is associated with worse survival outcomes in patients with early-stage NSCLC, particularly for men and for SCC.