1
|
Liao KM, Lee CS, Wu YC, Shu CC, Ho CH. Prior treated tuberculosis and mortality risk in lung cancer. Front Med (Lausanne) 2023; 10:1121257. [PMID: 37064038 PMCID: PMC10090669 DOI: 10.3389/fmed.2023.1121257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/03/2023] [Indexed: 03/31/2023] Open
Abstract
BackgroundLung cancer is one of the leading causes of cancer death worldwide, and tuberculosis (TB) is a common pre-existing disease. However, there is scarce literature studying the mortality risk in patients with prior TB and subsequent lung cancer.MethodsWe recruited lung cancer patients from the Taiwan Cancer Registry from 2011 to 2015 and classified them into two groups according to presence or absence of prior TB. We then matched them in a ratio of 1:4 using the exact matching approach. The mortality risk within 3 years after diagnosis of lung cancer was analyzed and compared between these two groups.ResultsDuring the study period, 43,472 patients with lung cancer were recruited, and of these, 1,211 (2.79%) patients had prior TB. After matching, this cohort included 5,935 patients with lung cancer in two groups: patients with prior TB before lung cancer (n = 1,187) and those without (n = 4,748). After controlling for demographic factors and comorbidities, the patients with prior TB had increased adjusted hazard ratios of 1.13 (95% CI: 1.04–1.23) and 1.11 (1.02–1.21) for all-cause and cancer-specific 3-year mortality, respectively, compared to the lung cancer patients without prior TB. Duration between TB and lung cancer (<1 year vs. 1–3 years vs. >3 years) had no differences for mortality risk.ConclusionIn the present study, 2.79% patients with lung cancer had prior TB, which was associated with higher 3-year mortality after they developed lung cancer. The mortality risk with prior TB did not decrease even if >3 years passed before diagnosis of lung cancer.
Collapse
Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan
| | - Chung-Shu Lee
- Department of Pulmonary and Critical Care Medicine, New Taipei Municipal Tu Cheng Hospital, New Taipei City, Taiwan
- Department of Thoracic Medicine, Chang Gung Memorial Hospital, School of Medicine, Chang Gung University, Taipei, Taiwan
| | - Yu-Cih Wu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Chin-Chung Shu,
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
- Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Cancer Center, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
- Chung-Han Ho,
| |
Collapse
|
2
|
The Prognostic Long-Term Impact of Chronic Obstructive Pulmonary Disease and Postoperative Mucostasis in Patients with Curatively Resected Non-Small Cell Lung Cancer. Cells 2023; 12:cells12030480. [PMID: 36766822 PMCID: PMC9914637 DOI: 10.3390/cells12030480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 01/25/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Chronic obstructive pulmonary disease (COPD) serves as risk factor for the development of lung cancer and seems to have a prognostic impact after surgery for non-small cell lung cancer (NSCLC). The aim was to investigate the impact of COPD and postoperative mucostasis on the long-term survival after resected NSCLC. We retrospectively reviewed the data from 342 patients with curatively resected NSCLC. The prognostic long-term impact of COPD and postoperative mucostasis on overall survival (OS), recurrence free survival (RFS) and cancer specific survival (CSS) was calculated using univariable and multivariable Cox regression analyses. We found that 52.3% suffered from COPD and 25.4% had postoperative mucostasis. COPD was significantly more common among smokers (59.9%) compared with non-smokers (21.3%), (p < 0.001). There was a significant relationship between COPD and postoperative mucostasis (p = 0.006) and between smoking and mucostasis (p = 0.023). Patients with postoperative mucostasis had a significantly worse OS (p < 0.001), RFS (p = 0.009) and CSS (p = 0.008). The present analysis demonstrated that postoperative mucostasis, but not COPD, was associated with both worse short- and long-term outcomes for OS, RFS and CSS in curatively resected NSCLC.
Collapse
|
3
|
Liao KM, Hung CM, Shu CC, Lee HS, Wei YF. Impact of Chronic Obstructive Pulmonary Disease on the Mortality of Patients with Small Cell Lung Cancer. Int J Chron Obstruct Pulmon Dis 2021; 16:3255-3262. [PMID: 34880609 PMCID: PMC8645948 DOI: 10.2147/copd.s328938] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Limited studies have focused on the impact of the coexistence of small cell lung cancer (SCLC) and chronic obstructive pulmonary disease (COPD). The study was to examine the impact of COPD on mortality in SCLC patients. Methods We analyzed SCLC patients from the Taiwan Cancer Registry Database between January 1, 1997, and December 31, 2015. The COPD population was composed of patients with a COPD diagnosis before the diagnosis of SCLC. The control group was composed of randomly selected SCLC patients without COPD who were propensity score matched with those with concomitant COPD according to age, sex, index date, cancer staging and comorbidities at a 1:1 ratio. Results Among 9425 SCLC patients in the database, eligible subjects were divided into the COPD group (n = 4235) and the non-COPD group (n = 2334). Compared to patients in the non-COPD group, the patients in the COPD group were older (71.4 versus 65.7 years, p<0.0001), had a lower percentage of stage IV disease (60.1% versus 68.3%, p<0.0001) and had more comorbidities. After matching, there were 1457 patients in each group. Older age, lower body mass index (BMI), and some comorbidities were associated with higher mortality, and comorbid COPD was associated with lower 1-year mortality in SCLC patients. Multivariate analysis identified older age, lower BMI, and concomitant congestive heart failure or diabetes as risk factors for OS. Conclusion A diagnosis of COPD was associated with reduced 1-year mortality in SCLC patients, but no significant difference after 1-year in this population.
Collapse
Affiliation(s)
- Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Tainan, Taiwan
| | - Chao-Ming Hung
- Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ho-Sheng Lee
- Division of Chest Medicine, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Yu-Feng Wei
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan.,Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung, Taiwan
| |
Collapse
|
4
|
Heo IR, Kim HC, Lee SJ, Yoo JW, Ju S, Jeong YY, Lee JD, Cho YJ, Jeong JH, Heo M, Jung SW, Kim TH. Impact of coexistent preserved ratio impaired spirometry on the survival of patients with lung cancer: Analysis of data from the Korean Association for Lung Cancer Registry. Thorac Cancer 2021; 12:2478-2486. [PMID: 34337879 PMCID: PMC8447913 DOI: 10.1111/1759-7714.14095] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Preserved ratio impaired spirometry (PRISm) is a common spirometric pattern that is associated with respiratory symptoms and higher mortality rates. However, the relationship between lung cancer and PRISm remains unclear. This study investigated the clinical characteristics of lung cancer patients with PRISm and the potential role of PRISm as a prognostic factor. METHODS We retrospectively reviewed data collected from 2014 to 2015 in the Korean Association for Lung Cancer Registry. We classified all patients into three subgroups according to lung function as follows: normal lung function; PRISm (forced expiratory volume in 1 s [FEV1 ] < 80% predicted and FEV1 /forced vital capacity [FVC] ≥ 0.7); and chronic obstructive pulmonary disease (COPD; FEV1/FVC < 0.7). In non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), the overall survival period was compared among the three subgroups. The prognostic factors were investigated using Cox regression analysis. RESULTS Of the 3763 patients, 38.6%, 40.1%, and 21.3% had normal lung function, COPD, and PRISm, respectively. Patients with PRISm had poorer overall survival than those with COPD or normal lung function in NSCLC and SCLC (Mantel-Cox log-rank test, p < 0.05). In the risk-adjusted analysis, overall survival was independently associated with COPD (hazard ratio [HR] 1.209, p = 0.027) and PRISm (HR 1.628, p < 0.001) in NSCLC, but was only associated with PRISm (HR 1.629, p = 0.004) in SCLC. CONCLUSIONS PRISm is a significant pattern of lung function in patients with lung cancer. At the time of lung cancer diagnosis, pre-existing PRISm should be considered a predictive factor of poor prognosis.
Collapse
Affiliation(s)
- I Re Heo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ho Cheol Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Seung Jun Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung-Wan Yoo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Sunmi Ju
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yi Yeong Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong Deog Lee
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yu Ji Cho
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong Hwan Jeong
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Manbong Heo
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung Woo Jung
- Department of Critical Care Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Tae Hoon Kim
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| |
Collapse
|
5
|
Gao G, Zhou C, Huang Y, Hong Z, Yu P, Chen Y, Gao J, Zhang K, Xie Z, Zhang J, Li S, Masashi N, Qin Y. Randomized phase III study comparing the first-line chemotherapy regimens in patients with driver mutation-negative advanced non-small cell lung cancer and poor performance status complicated with chronic obstructive pulmonary disease. Transl Lung Cancer Res 2021; 10:2573-2587. [PMID: 34295663 PMCID: PMC8264331 DOI: 10.21037/tlcr-21-371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 06/11/2021] [Indexed: 11/09/2022]
Abstract
Background Patients with non-small cell lung cancer (NSCLC) complicated with chronic obstructive pulmonary disease (COPD) with poor performance status (PS) are common in clinical practice with few related studies. Present studies have found that weekly low-dose docetaxel or gemcitabine combined with platinum is suitable for elderly or poor PS patients with advanced NSCLC. Methods Untreated advanced driver mutation-negative NSCLC patients with COPD and PS ≥2 were enrolled in this double-blind randomized trial. Both groups controlled their COPD symptoms according to the GOLD guidelines. The anti-tumor regimens included docetaxel (37.5 mg/m2, D1, D8)/carboplatin (AUC 5.0) (DC group) and gemcitabine (1,000 mg/m2, D1, D8)/carboplatin (AUC 5.0) (GC group) were used every 3 weeks with continuous chemotherapy for 4–6 cycles or until disease progression. The primary endpoints were progression-free survival (PFS), and overall survival (OS). Results Among the 52 patients (DC, n=25; GC, n=27), the median follow-up time was 12.3 months. There was no significant difference in tumor overall response rate (ORR; DC, 20.0% vs. GC, 22.2%, P=0.845) and disease control rate (DCR; DC, 72.0% vs. GC, 74.1%, P=0.064) between the 2 groups. The median PFS (GC, 6.5 vs. DC, 5.5 months; P=0.296) and the median OS (GC, 14.9 vs. DC, 12.3 months; P=0.548) of the GC group was slightly longer than the DC group. The main adverse reactions were myelosuppression and there were few adverse reactions of grade 3–4. Compared with the anti-tumor therapy only group in previous literature, the median PFS in this study was longer (6.2 months, 95% CI: 3.533–6.733 vs. 3.5 months, 95% CI: 2.432–4.568; P=0.589). There was also no significant difference in median OS and median PFS between the 2 groups (14.0 vs. 15.0 months, P=0.718). Chemotherapy cycle (P<0.001) was an independent prognostic factor for PFS, while chemotherapy cycle (P=0.011) and PS (P=0.041) were independent prognostic factors for OS. Conclusions Weekly low-dose docetaxel or gemcitabine combined with carboplatin chemotherapy regimens can yield survival benefits and a tolerable safety profile in patients with driver mutation-negative advanced NSCLC and poor PS complicated with COPD, with no significant difference between the two regimens. Trial Registration Chinese Clinical Trial Registry ChiCTR-IPR-15006164.
Collapse
Affiliation(s)
- Guoying Gao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Pulmonary and Critical Care Medicine, Panyu Central Hospital, Guangzhou, China
| | - Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yucheng Huang
- Pulmonary and Critical Care Medicine, Shunde Affiliated Hospital of Guangzhou Medical University (Lecong Hospital of Shunde District), Foshan, China
| | - Ziying Hong
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Pei Yu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Ying Chen
- Pulmonary and Critical Care Medicine, Shunde Affiliated Hospital of Guangzhou Medical University (Lecong Hospital of Shunde District), Foshan, China
| | - Jiabo Gao
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Kening Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Zhanhong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiexia Zhang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Nagata Masashi
- Department of General Surgery, Okinawa Kyodo Hospital, Naha, Okinawa, Japan
| | - Yinyin Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Pulmonary and Critical Care Medicine, Shunde Affiliated Hospital of Guangzhou Medical University (Lecong Hospital of Shunde District), Foshan, China
| |
Collapse
|
6
|
Zhou C, Li S, Liu J, Chu Q, Miao L, Cai L, Cai X, Chen Y, Cui F, Dong Y, Dong W, Fang W, He Y, Li W, Li M, Liang W, Lin G, Lin J, Lin X, Liu H, Liu M, Mu X, Hu Y, Hu J, Jin Y, Li Z, Qin Y, Ren S, Sun G, Shen Y, Su C, Tang K, Wu L, Wang M, Wang H, Wang K, Wang Y, Wang P, Wang H, Wang Q, Wang Z, Xie X, Xie Z, Xu X, Xu F, Yang M, Yang B, Yi X, Ye X, Ye F, Yu Z, Yue D, Zhang B, Zhang J, Zhang J, Zhang X, Zhang W, Zhao W, Zhu B, Zhu Z, Zhong W, Bai C, Chen L, Han B, Hu C, Lu S, Li W, Song Y, Wang J, Zhou C, Zhou J, Zhou Y, Saito Y, Ichiki Y, Igai H, Watanabe S, Bravaccini S, Fiorelli A, Petrella F, Nakada T, Solli P, Tsoukalas N, Kataoka Y, Goto T, Berardi R, He J, Zhong N. International consensus on severe lung cancer-the first edition. Transl Lung Cancer Res 2021; 10:2633-2666. [PMID: 34295668 PMCID: PMC8264326 DOI: 10.21037/tlcr-21-467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/17/2021] [Indexed: 02/05/2023]
Affiliation(s)
- Chengzhi Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shiyue Li
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jun Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Qian Chu
- Department of Oncology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Liyun Miao
- Department of Respiratory and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Linbo Cai
- Department of Oncology, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Xiuyu Cai
- Department of General Internal Medicine, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Cui
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuchao Dong
- Department of Pulmonary and Critical Care Medicine, Shanghai Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Wen Dong
- Department of Oncology, Hainan Cancer Hospital, Haikou, China
| | - Wenfeng Fang
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yong He
- Department of Respiratory Medicine, Daping Hospital, Army Medical University, Chongqing, China
| | - Weifeng Li
- Department of Respiratory Medicine, General Hospital of Guangzhou Military Command of PLA, Guangzhou, China
| | - Min Li
- Department of Respiratory Medicine, Xiangya Cancer Center, Xiangya Hospital, Central South University, Changsha, China
| | - Wenhua Liang
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Gen Lin
- Department of Thoracic Oncology, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Jie Lin
- Department of Medical Oncology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xinqing Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Hongbing Liu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Ming Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinlin Mu
- Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing, China
| | - Yi Hu
- Department of Medical Oncology, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jie Hu
- Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Jin
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ziming Li
- Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yinyin Qin
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shengxiang Ren
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Thoracic Cancer Institute, Tongji University School of Medicine, Shanghai, China
| | - Gengyun Sun
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yihong Shen
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxia Su
- Department of Medical Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Kejing Tang
- Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Institute of Pulmonary Diseases, Sun Yat-sen University, Guangzhou, China
| | - Lin Wu
- Thoracic Medicine Department II, Hunan Cancer Hospital, Changsha, China
| | - Mengzhao Wang
- Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Beijing, China
| | - Huijuan Wang
- Department of Medical Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Kai Wang
- Department of Respiratory Medicine, Fourth Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China
| | - Yuehong Wang
- Department of Respiratory Disease, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, the Eighth Medical Center of PLA General Hospital, Beijing, China
| | - Hongmei Wang
- Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Qi Wang
- Department of Respiratory Medicine, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Zhijie Wang
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhanhong Xie
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xin Xu
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fei Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Meng Yang
- Department of Respiratory Disease, China-Japan Friendship Hospital, Beijing, China
| | - Boyan Yang
- Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China.,Department of Comprehensive Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangjun Yi
- Department of Medical Oncology, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xiaoqun Ye
- Department of Respiratory Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Feng Ye
- Department of Medical Oncology, The first affiliated hospital of Xiamen University, Xiamen, China
| | - Zongyang Yu
- Department of Pulmonary and Critical Care Medicine, The th Hospital of Joint Logistic Support Force, PLA, Fuzhou, China
| | - Dongsheng Yue
- Department of Lung Cancer, Tianjin Lung Cancer Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Bicheng Zhang
- Cancer Center, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jian Zhang
- Department of Pulmonary and Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Jianqing Zhang
- Second Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wei Zhao
- Department of Pulmonary and Critical Care Medicine, The General Hospital of People's Liberation Army, Beijing, China
| | - Bo Zhu
- Institute of Cancer, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Zhengfei Zhu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wenzhao Zhong
- Guangdong Lung Cancer Institute, Guangdong General Hospital, and Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chunxue Bai
- Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Liangan Chen
- Department of Respiratory, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baohui Han
- Department of Pulmonology, Shanghai Chest Hospital, Shanghai, China
| | - Chengping Hu
- Department of Pulmonary Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Shun Lu
- Department of Oncology, Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Weimin Li
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Song
- Department of Respiratory and Critical Care Medicine, Jinling Hospital, Nanjing, China
| | - Jie Wang
- Key Laboratory of Respiratory Disease Pathogenomics, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Caicun Zhou
- Department of Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital of College of Medicine, Zhejiang University, Hangzhou, China
| | - Yanbin Zhou
- Department of Internal Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuichi Saito
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinobu Ichiki
- Department of General Thoracic Surgery, National Hospital Organization, Saitama Hospital, Wako, Japan
| | - Hitoshi Igai
- Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Satoshi Watanabe
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sara Bravaccini
- IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Universitàdella Campania Luigi Vanvitelli, Naples, Italy
| | - Francesco Petrella
- Division of Thoracic Surgery, IRCCS European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - Takeo Nakada
- Division of Thoracic Surgery, Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Piergiorgio Solli
- Department of Cardio-Thoracic Surgery and Hearth & Lung Transplantation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto, Japan
| | - Taichiro Goto
- Lung Cancer and Respiratory Disease Center, Yamanashi Central Hospital, Yamanashi, Japan
| | - Rossana Berardi
- Clinica Oncologica, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi di Ancona, Italy
| | - Jianxing He
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
7
|
Shin SH, Shin S, Im Y, Lee G, Jeong BH, Lee K, Um SW, Kim H, Kwon OJ, Cho JH, Kim HK, Choi YS, Kim J, Zo JI, Shim YM, Cho J, Kang D, Park HY. Effect of perioperative bronchodilator therapy on postoperative pulmonary function among lung cancer patients with COPD. Sci Rep 2021; 11:8359. [PMID: 33863912 PMCID: PMC8052420 DOI: 10.1038/s41598-021-86791-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 02/24/2021] [Indexed: 11/09/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD), an established risk factor for lung cancer, remains largely undiagnosed and untreated before lung cancer surgery. We evaluated the effect of perioperative bronchodilator therapy on lung function changes in COPD patients who underwent surgery for non-small cell lung cancer (NSCLC). From a database including NSCLC patients undergoing lung resection, COPD patients were identified and divided into two groups based on the use of bronchodilator during the pre- and post-operative period. Changes in forced expiratory volume in 1 s (FEV1) and postoperative complications were compared between patients treated with and without bronchodilators. Among 268 COPD patients, 112 (41.8%) received perioperative bronchodilator, and 75% (84/112) were newly diagnosed with COPD before surgery. Declines in FEV1 after surgery were alleviated by perioperative bronchodilator even after adjustments for related confounding factors including surgical extent, surgical approach and preoperative FEV1 (adjusted mean difference in FEV1 decline [95% CI] between perioperative bronchodilator group and no perioperative bronchodilator group; - 161.1 mL [- 240.2, - 82.0], - 179.2 mL [- 252.1, - 106.3], - 128.8 mL [- 193.2, - 64.4] at 1, 4, and 12 months after surgery, respectively). Prevalence of postoperative complications was similar between two groups. Perioperative bronchodilator therapy was effective to preserve lung function, after surgery for NSCLC in COPD patients. An active diagnosis and treatment of COPD are required for surgical candidates of NSCLC.
Collapse
Affiliation(s)
- Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sumin Shin
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Genehee Lee
- Patient-Centered Outcomes Research Institute, Samsung Medical Center, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyungjong Lee
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Jong Ho Cho
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jhingook Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jae Ill Zo
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juhee Cho
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Danbee Kang
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 81 Irwon-ro, Gangnam-Gu, Seoul, 06351, Republic of Korea.
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
| |
Collapse
|
8
|
Dai J, He Y, Maneenil K, Liu H, Liu M, Guo Q, Bennett AC, Stoddard SM, Wampfler JA, Jiang G, Yang P. Timing of chronic obstructive pulmonary disease diagnosis in lung cancer prognosis: a clinical and genomic-based study. Transl Lung Cancer Res 2021; 10:1209-1220. [PMID: 33889503 PMCID: PMC8044468 DOI: 10.21037/tlcr-20-1017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background A two-phase study (clinical and genomic-based) was conducted to evaluate the effect of timing of chronic obstructive pulmonary disease (COPD) diagnosis on lung cancer outcomes. Methods The prognostic influence of COPD was investigated in a clinical cohort of 1,986 patients who received surgery for stage I lung cancer; 823 (41.4%) of them also had COPD, including 549 (27.6%) incidental COPD (diagnosed within 6-months of lung cancer diagnosis) and 274 (13.8%) prior COPD (>6 months before lung cancer diagnosis). The genomic variations were analyzed from another cohort of 1,549 patients for association with 384 lung cancer-related single nucleotide polymorphisms (SNPs). Results Older age (≥70 years), smokers, and respiratory symptoms were independent predictors of incidental COPD in lung cancer (all P<0.05). Similar to prior COPD, incidental COPD increased postoperative complications and worsened quality-of-life related to dyspnea (both P<0.05). Multivariate Cox regression analysis showed lung cancer survival decreased significantly in incidental COPD (HR, 1.30; 95% CI, 1.02–1.66), but not in prior COPD (HR, 1.15; 95% CI, 0.87–1.52). Among prior COPD, median survival showed a trend for being better in those with fewer exacerbations (0–1 vs. ≥2 exacerbation/year; 6.1 vs. 4.1 years; P=0.10). The SNP-based analysis identified ADCY2:rs52827085 was significantly associated with risk of incidental COPD (OR, 1.76; 95% CI, 1.30–2.38) and NRXN1:rs1356888 associated with prior COPD complicated with lung cancer (OR, 1.73; 95% CI, 1.29–2.33). Conclusions Different long-term survival and genomic variants were observed between lung cancer patients with incidental and with prior COPD, suggesting timing of COPD diagnosis should be considered in lung cancer clinical management and mechanistic research.
Collapse
Affiliation(s)
- Jie Dai
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanqi He
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Kunlatida Maneenil
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA.,Oncology Unit, Department of Medicine, Rajavithi Hospital, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Han Liu
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Respiratory Medicine, the First Hospital of Jilin University, Changchun, China
| | - Ming Liu
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qian Guo
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Department of Medical Oncology, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Amy C Bennett
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Shawn M Stoddard
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jason A Wampfler
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Yang
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
9
|
Risk Factors for Short-Term Lung Cancer Survival. J Clin Med 2021; 10:jcm10030519. [PMID: 33535673 PMCID: PMC7867142 DOI: 10.3390/jcm10030519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Lung cancer is typically diagnosed in an advanced phase of its natural history. Explanatory models based on epidemiological and clinical variables provide an approximation of patient survival less than one year using information extracted from the case history only, whereas models involving therapeutic variables must confirm that any treatment applied is worse than surgery in survival terms. Models for classifying less than one year survival for patients diagnosed with lung cancer which are able to identify risk factors and quantify their effect for prognosis are analyzed. Method: Two stepwise binary logistic regression models, based on a retrospective study of 521 cases of patients diagnosed with lung cancer in the Interventional Pneumology Unit at the Hospital “Virgen de las Nieves”, Granada, Spain. Results: The first model included variables age, history of pulmonary neoplasm, tumor location, dyspnea, dysphonia, and chest pain. The independent risk factors age greater than 70 years, a peripheral location, dyspnea and dysphonia were significant. For the second model, treatments were also significant. Conclusions: Age, history of pulmonary neoplasm, tumor location, dyspnea, dysphonia, and chest pain are predictors for survival in patients diagnosed with lung cancer at the time of diagnosis. The treatment applied is significant for classifying less than one year survival time which confirms that any treatment is markedly inferior to surgery in terms of survival. This allows to consider applications of more or less aggressive treatments, anticipation of palliative cares or comfort measures, inclusion in clinical trials, etc.
Collapse
|
10
|
Ban WH, Yeo CD, Han S, Kang HS, Park CK, Kim JS, Kim JW, Kim SJ, Lee SH, Kim SK. Impact of smoking amount on clinicopathological features and survival in non-small cell lung cancer. BMC Cancer 2020; 20:848. [PMID: 32883225 PMCID: PMC7469911 DOI: 10.1186/s12885-020-07358-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Screening for early detection of lung cancer has been performed in high-risk individuals with smoking history. However, researches on the distribution, clinical characteristics, and prognosis of these high-risk individuals in an actual cohort are lacking. Thus, the objective of this study was to retrospectively review characteristics and prognosis of patients with smoking history in an actual lung cancer cohort. METHODS The present study used the lung cancer cohort of the Catholic Medical Centers at the Catholic University of Korea from 2014 to 2017. Patients with non-small cell lung cancer were enrolled. They were categorized into high and low-risk groups based on their smoking history using the national lung screening trial guideline. Distribution, clinical characteristics, and survival data of each group were estimated. RESULTS Of 439 patients, 223 (50.8%) patients were in the high-risk group. Patients in the high-risk group had unfavorable clinical characteristics and tumor biologic features. Overall survival of the high-risk group was significantly shorter than that of the low-risk group with both early (I, II) and advanced stages (III, IV). In multivariate analysis, heavy smoking remained one of the most important poor clinical prognostic factors in patients with lung cancer. It showed a dose-dependent relationship with patients' survival. CONCLUSIONS High-risk individuals had poor clinical outcomes. Patients' prognosis seemed to be deteriorated as smoking amount increased. Therefore, active screening and clinical attention are needed for high-risk individuals.
Collapse
Affiliation(s)
- Woo Ho Ban
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Solji Han
- Department of Applied Statistics, Yonsei University, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,The Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| |
Collapse
|
11
|
Lim JU, Han S, Kim HC, Choi CM, Jung CY, Cho DG, Jeon JH, Lee JE, Ahn JS, Kim Y, Choi YD, Suh YG, Kim JE, Won YJ, Kim YC, Park CK, Kim SJ. Characteristics of female lung cancer in Korea: analysis of Korean National Lung Cancer Registry. J Thorac Dis 2020; 12:4612-4622. [PMID: 33145034 PMCID: PMC7578488 DOI: 10.21037/jtd-20-1671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Backgrounds The present study evaluated Korean women with lung cancer and compared the clinical characteristics of ever-smoker and never-smoker groups using the National Lung Cancer Registry. Methods In affiliation with the Korean Central Cancer Registry, the Korean Association for Lung Cancer constructed a registry into which 10% of the lung cancer cases in Korea were registered. Female lung cancer patients with valid smoking history were evaluated. Results Among 735 female lung cancer patients, 643 (87.5%) were never-smokers and 92 (12.5%) were smokers. The median survival was significantly longer in the never-smoker group (28 vs. 14 months; P<0.001). Among 683 patients with non-small cell lung cancer (NSCLC), the never-smoker group showed significantly longer median survival (29 vs. 14 months; P=0.002) and a higher proportion of stage I cancer (40.3% vs. 25.7%; P<0.001). Survival analysis of the NSCLC patients showed that smoking status, receiving only supportive care, EGFR mutation status, lung cancer stage, and forced vital capacity (FVC) (%) were significantly associated with mortality in the multivariate analysis (P=0.025, HR 2.39, 95% CI: 1.12–5.11; P=0.017, HR 3.14, 95% CI: 1.22–8.06; P=0.033, HR 0.63, 95% CI: 0.41–0.96; P<0.001, HR 11.88, 95% CI: 5.79–24.38; P=0.002, HR 0.98, 95% CI: 0.96–0.99, respectively). Conclusions In Korean women with NSCLC, smoking status, not receiving active anticancer treatment, EGFR mutation status, lung cancer stage, and pulmonary function were significantly associated with mortality.
Collapse
Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Solji Han
- Department of Applied Statistics, Yonsei University, Seoul, Korea
| | - Ho Cheol Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Chang Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea
| | - Chi Young Jung
- Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Deog Gon Cho
- Department of Thoracic & Cardiovascular Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jae Hyun Jeon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Eun Lee
- Division of Pulmonology Department of Internal Medicine, Chungnam National University, Daejeon, Korea
| | - Jin Seok Ahn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Korea
| | - Yeongdae Kim
- Department of Cardiothoracic Surgery, Pusan National University Hospital, Pusan, Korea
| | - Yoo-Duk Choi
- Department of Pathology, Chonnam National University, Hwasun Hospital, Hwasun, Korea
| | - Yang-Gun Suh
- Proton Therapy Center, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jung-Eun Kim
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Young-Joo Won
- Cancer Registration and Statistics Branch, National Cancer Center, Goyang, Korea
| | - Young-Chul Kim
- Department of Internal Medicine, Chonnam National University, Hwasun Hospital, Hwasun, Korea
| | - Chan Kwon Park
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Joon Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.,Postech-Catholic Biomedical Engineering Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
12
|
Cireli E, Balcı G, Mertoğlu A. How does chronic obstructive pulmonary disease affect the survival of patients with stage 4 lung cancer? CLINICAL RESPIRATORY JOURNAL 2020; 14:1025-1031. [PMID: 32706913 DOI: 10.1111/crj.13237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 05/19/2020] [Accepted: 07/14/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Lung cancer risk is increased in COPD. However, it is not clear how COPD affects the course of lung cancer. AIM To determine whether the overall survival of stage 4 lung cancer patients differ in various COPD stages. STUDY DESIGN A cross-sectional retrospective study. METHODS We screened lung cancer patients with ICD code: C34 and included stage 4 lung cancer patients with histological diagnosis and pulmonary function tests at admission in the study. Demographic data, stages, metastasis sites and number of metastases, performance status, pulmonary function tests, Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages, arterial blood gasses and treatment methods were recorded on a standardised database. We checked their dates of death from national database. Data were evaluated with SPSS programme version 18. RESULTS Out of 900 patients, 146 patients had stage 4 disease at the time of diagnosis and, 127 patients had COPD. There was a significant difference between survivals of stage 4 cancer patients with different COPD stages. As COPD stage increased, overall survival worsened (P = 0.037). Factors affecting survival were bone metastasis (P = 0.01, OR = 1.72), liver metastasis (P = 0.04, OR = 1.87), brain metastasis (P = 0.001, OR = 2.6), having N 2-3 disease (P = 0.01, OR = 1.79) and GOLD 4 COPD (P = 0.01, OR = 2.28). CONCLUSION As COPD becomes more severe, overall survival rates of stage 4 patients worsen. Bone metastasis, liver metastasis, brain metastasis, having N2-3 disease and GOLD 4 COPD worsen the overall survival.
Collapse
Affiliation(s)
- Emel Cireli
- Pulmonary Diseases SUAM, Pulmonary Physician, SBU Izmir Chest Diseases and Surgery Training Hospital, Izmir, Turkey
| | - Günseli Balcı
- Pulmonary Diseases SUAM, Pulmonary Physician, SBU Izmir Chest Diseases and Surgery Training Hospital, Izmir, Turkey
| | - Aydan Mertoğlu
- Pulmonary Diseases SUAM, Pulmonary Physician, SBU Izmir Chest Diseases and Surgery Training Hospital, Izmir, Turkey
| |
Collapse
|
13
|
Nagata M, Ito H, Yoshida T, Tokushige A, Ueda S, Yokose T, Nakayama H. Risk factors for progressive sarcopenia 6 months after complete resection of lung cancer: what can thoracic surgeons do against sarcopenia? J Thorac Dis 2020; 12:307-318. [PMID: 32274097 PMCID: PMC7138994 DOI: 10.21037/jtd.2020.01.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Our previous report described how postoperative progression of sarcopenia predicted long-term prognosis after complete resection of non-small cell lung cancer (NSCLC) in heavy smokers. However, there are currently no effective means to treat progressive sarcopenia. In this study, we aimed to confirm our previous findings in a larger population and to identify factors associated with postoperative progression of sarcopenia to propose possible preventative measures. Methods This retrospective study analyzed the data of 1,095 patients who underwent curative lobar resection for NSCLC at Kanagawa Cancer Center. We divided patients into four groups according to sex and Brinkman index (BI) above or below 600. Six-month postoperative changes in the skeletal muscle index (SMI) were calculated and associations between clinicopathological factors including changes in SMI and mortality from postoperative 6 months were examined. Only in groups in which postoperative depletion of SMI was shown to be associated with the prognosis, we identified clinicopathological factors associated with depletive SMI. Results The overall survival rates of 1,095 patients were 89.8% and 82.5% at 3 and 5 years, respectively. The median 6-month change in SMI was –3.4% (range, −22.3% to +17.9%). Multivariate analysis revealed that poor prognosis was independently predicted by a large reduction in the SMI (cut-off value: −10%) in males with a BI ≥600. In 391 heavy-smoking males, factors associated with a postoperative change in SMI ≤−10% were history of other cancers (including gastric cancer) low forced expiratory volume in one second (FEV 1.0, cut-off value: 1,870 mL), and prolonged operation time (cut-off value: 200 minutes). Conclusions Perioperative measures to prevent postoperative sarcopenia are appropriate for heavy smokers. We obtained some clues regarding countermeasures, one of which may be avoiding long-time operation. Further studies including clinical trials to assess perioperative anti-sarcopenia treatments, are needed.
Collapse
Affiliation(s)
- Masashi Nagata
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan.,Department of General Surgery, Okinawa Kyodo Hospital, Naha, Japan.,Department of Clinical Research and Quality Management, Graduate School of medicine, University of The Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| | - Tetsuo Yoshida
- Department of Diagnostic and Interventional Radiology, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| | - Akihiro Tokushige
- Department of Clinical Research and Quality Management, Graduate School of medicine, University of The Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Shinichiro Ueda
- Department of Clinical Research and Quality Management, Graduate School of medicine, University of The Ryukyus, Nishihara-cho, Okinawa, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| |
Collapse
|
14
|
Wu K, Wang J, Zhao L, Wang P, Duan Q. The prognosis of non-small cell lung cancer combined with chronic obstructive pulmonary disease: A systematic review and meta-analysis. CLINICAL RESPIRATORY JOURNAL 2020; 14:389-396. [PMID: 31905419 PMCID: PMC7187245 DOI: 10.1111/crj.13144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/20/2019] [Accepted: 01/02/2020] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate the effect of non-small cell lung cancer (NSCLC) combined with Chronic Obstructive Pulmonary Disease (COPD) on prognosis, so as to provide help to clinical diagnosis and treatment. METHODS PubMed, Web of Science and the Medline were used to retrieve studies reported from 1950 to 2019. If the study reported the prognosis of COPD with NSCLC, the study was included and the relevant information was extracted and the data analyzed. The standard mean deviation (SMD) of 95% confidence interval was used in this meta-analysis. RESULTS A total of 851 data studies were reviewed for eligibility, eventually, 12 case-control studies were included in this systematic review and meta-analysis. The sample sizes for company's studies of NSCLC ranged from 85 to 10 378, with a total number of 14 164, including 2450 COPD and 9395 Non-COPD. Meta-analyses showed that concomitant COPD was associated with poorer OS compared with patients without COPD (Fixed: HR: 1.16; 95% CI: 1.08-1.25. Random: HR: 1.07; CI: 0.92-1.24), with a significant heterogeneity across studies (I2 = 45%, P = 0.04). CONCLUSION Our study showed that patients with combined COPD had an impact on the prognosis and survival rate of SCLC patients.
Collapse
Affiliation(s)
- Ke Wu
- Department of Respiratory and Critical Care Medicine, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Wang
- Department of Respiratory Medicine, People's Hospital of Henan University, Zhengzhou, China
| | - Limin Zhao
- Department of Respiratory Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Pei Wang
- Department of Respiratory Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Qi Duan
- Department of Respiratory Medicine, The Fifth Affiliated Hospital Of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
15
|
Lin J, McGlynn KA, Nations JA, Shriver CD, Zhu K. Comorbidity and stage at diagnosis among lung cancer patients in the US military health system. Cancer Causes Control 2020; 31:255-261. [PMID: 31984449 DOI: 10.1007/s10552-020-01269-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 01/18/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE We investigated the association between comorbidities and stage at diagnosis among NSCLC patients in the US Military Health System (MHS), which provides universal health care to its beneficiaries. METHODS The linked data from the Department of Defense's Central Cancer Registry (CCR) and the MHS Data Repository (MDR) were used. The study included 4768 patients with histologically confirmed primary NSCLC. Comorbid conditions were extracted from the MDR data. Comorbid conditions were those included in the Charlson Comorbidity Index (CCI) and were defined as a diagnosis during a 3-year time frame prior to the NSCLC diagnosis. Multivariable logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals (95% CI) of late stage (stages III and IV) versus early stage (stages I and II) in relation to pre-existing comorbidities. RESULTS Compared to patients with no comorbidities, those with prior comorbidities tended to be less likely to have lung cancer diagnosed at late stage. When specific comorbidities were analyzed, decreased odds of being diagnosed at late stage were observed among those with chronic obstructive pulmonary disease (COPD) (adjusted OR 0.78, 95% CI 0.68 to 0.90). In contrast, patients with a congestive heart failure or a liver cirrhosis/chronic hepatitis had an increased likelihood of being diagnosed at late stage (adjusted OR 1.30, 95% CI 1.00 to 1.69 and adjusted OR 1.87, 95% CI 1.24 to 2.82, respectively). CONCLUSIONS Among NSCLC patients in an equal access health system, the likelihood of late stage at diagnosis differed by specific comorbid diseases.
Collapse
Affiliation(s)
- Jie Lin
- John P. Murtha Cancer Center Research Program, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA.
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, 20814, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA.
| | - Katherine A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Joel A Nations
- John P. Murtha Cancer Center Research Program, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA
| | - Craig D Shriver
- John P. Murtha Cancer Center Research Program, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, 20814, USA
| | - Kangmin Zhu
- John P. Murtha Cancer Center Research Program, Uniformed Service University of the Health Sciences and Walter Reed National Military Medical Center, 6720A Rockledge Drive, Suite 310, Bethesda, MD, 20817, USA.
- Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, 20814, USA.
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of Health Sciences, Bethesda, MD, 20814, USA.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA.
| |
Collapse
|
16
|
Dong W, Zhu Y, Du Y, Wang L, Feng X, Ma S. Impact of severe-to-very severe chronic obstructive pulmonary disease on the prognosis of patients with non-small cell lung cancer who received chemotherapy. CLINICAL RESPIRATORY JOURNAL 2020; 14:345-352. [PMID: 31876095 DOI: 10.1111/crj.13139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/13/2019] [Accepted: 12/18/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is associated with poor prognosis in non-small cell lung cancer (NSCLC) patients. There are limited data about the impact of severe-to-very severe COPD on prognosis in patients with NSCLC receiving first-line chemotherapy. OBJECTIVES To investigate whether severe-to-very severe COPD impacted survival of patients with NSCLC receiving first-line chemotherapy. METHODS A retrospective review was performed on 513 consecutive NSCLC patients receiving first-line chemotherapy between February 2014 and May 2018. Prognostic impact of severe-to-very severe COPD was analysed using regression analyses. RESULTS Totally 258 NSCLC patients (118 non-COPD, 96 mild-to-moderate COPD and 44 severe-to-very severe COPD) were evaluated retrospectively. Kaplan-Meier analysis showed that the median overall survival times in the severe-to-very severe COPD, mild-to-moderate COPD and non-COPD groups were 14.0 months [95% confidence interval (CI): 11.0-17.0], 18 months (95% CI: 14.8-21.2) and 19 months (95% CI: 15.3-22.7), respectively. The difference was significant between patients with severe-to-very severe COPD and those without COPD (χ2 = 6.8, P = 0.009) and between patients with severe-to-very severe COPD and those with mild-to-moderate COPD (χ2 = 4.0, P = 0.045). Multivariate analysis showed that survival time was significantly shorter in the severe-to-very severe COPD group than in the non-COPD group (adjusted hazard ratio: 1.876, 95% CI: 1.161-3.030, P = 0.01) and mild-to-moderate COPD group (adjusted hazard ratio: 1.782, 95% CI: 1.046-3.034, P = 0.033). CONCLUSION Severe-to-very severe COPD may worsen the prognosis of NSCLC patients who received first-line chemotherapy.
Collapse
Affiliation(s)
- Weigang Dong
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yaqian Zhu
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Yan Du
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Lina Wang
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Xue Feng
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| | - Shuping Ma
- Department of Respiratory and Critical Care Medicine, Tianjin Chest Hospital, Tianjin, People's Republic of China
| |
Collapse
|
17
|
Hardavella G, Karampinis I, Styliara P, Kainis I. Lung Cancer Surgery in Patients with Chronic Obstructive Pulmonary Disease (COPD): Surgical Selection Challenges and Clinical Outcomes. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190531104506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Health care systems worldwide are commonly burdened with COPD and lung cancer and
subsequently much has been studied and learnt of the interdependence between these two clinical
entities. Lung cancer surgical treatment options in patients with severe COPD remain a clinical
challenge for the multidisciplinary team. Appropriate patient selection and prediction of
postoperative pulmonary complications aid in surgical decision making and informed patient
consent. In this review, we present an overview of surgical selection tools (lung function parameters,
risk stratification for postoperative pulmonary complications) and lung cancer clinical outcomes
(recurrence, survival) in patients with COPD undergoing lung cancer surgery.
Collapse
Affiliation(s)
- Georgia Hardavella
- 10th Department of Respiratory Medicine, Athens Chest Diseases Hospital ‘Sotiria’, Athens, Greece
| | - Ioannis Karampinis
- Department of Thoracic Sur gery, ‘Sismanogleio’ General Hospital, Athens, Greece
| | - Panagiota Styliara
- 10th Department of Respiratory Medicine, Athens Chest Diseases Hospital ‘Sotiria’, Athens, Greece
| | - Ilias Kainis
- 10th Department of Respiratory Medicine, Athens Chest Diseases Hospital ‘Sotiria’, Athens, Greece
| |
Collapse
|
18
|
Lee SY, Choi YJ, Seo JH, Lee SY, Kim JS, Kang EJ. Pulmonary function is implicated in the prognosis of metastatic non-small cell lung cancer but not in extended disease small cell lung cancer. J Thorac Dis 2019; 11:4562-4572. [PMID: 31903245 DOI: 10.21037/jtd.2019.10.77] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background The impacts of pulmonary function in patients with metastatic non-small cell lung cancer (NSCLC) and extended disease stage small cell lung cancer (SCLC-ED) treated with palliative chemotherapy remain to still be determined. Methods Results of spirometry performed in 449 patients with either stage IV NSCLC (n=313) or SCLC-ED (n=136) at diagnosis were reviewed retrospectively. Overall survival (OS) was estimated using the Kaplan-Meier method and compared via a log-rank test. Multivariate analysis was performed using a Cox proportional hazards regression model. Results The presence of chronic obstructive pulmonary disease (COPD) was not a risk factor for OS in either NSCLC or SCLC. However, NSCLC patients with COPD with a forced expiratory volume in one second (FEV1) value of less than 80% predicted were associated with a worse OS in both univariate and multivariate analyses [hazard ratio (HR): 1.43; 95% confidence interval (CI): 1.04-1.97; P=0.03]. Intriguingly, only the OS of NSCLC patients treated with chemotherapeutic agents was affected by the airflow limitation FEV1 value of less than 80% predicted (P=0.02). Patients with an FEV1 value of less than 80% predicted treated with targeted agents were not associated with OS (P=0.24). On the other hand, NSCLC patients with COPD were significantly linked to the occurrence of pulmonary complications during palliative therapy (P=0.01) but not associated with death resulting from pulmonary complications (P=0.22). Conclusions Careful attention is required when chemotherapeutic agents are administered to patients with metastatic NSCLC with accompanying COPD with a FEV1 value of less than 80% predicted.
Collapse
Affiliation(s)
- Suk-Young Lee
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Yoon Ji Choi
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Jae Hong Seo
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Sung Yong Lee
- Division of Pulmonology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Jung Sun Kim
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| | - Eun Joo Kang
- Division of Oncology/Hematology, Department of Internal Medicine, College of Medicine, Korea University, Seoul 08308, Republic of Korea
| |
Collapse
|
19
|
Perrotta F, Cennamo A, Cerqua FS, Stefanelli F, Bianco A, Musella S, Rispoli M, Salvi R, Meoli I. Effects of a high-intensity pulmonary rehabilitation program on the minute ventilation/carbon dioxide output slope during exercise in a cohort of patients with COPD undergoing lung resection for non-small cell lung cancer. ACTA ACUST UNITED AC 2019; 45:e20180132. [PMID: 31618297 PMCID: PMC7447542 DOI: 10.1590/1806-3713/e20180132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 01/30/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Preoperative functional evaluation is central to optimizing the identification of patients with non-small cell lung cancer (NSCLC) who are candidates for surgery. The minute ventilation/carbon dioxide output (VE/VCO2) slope has proven to be a predictor of surgical complications and mortality. Pulmonary rehabilitation programs (PRPs) could influence short-term outcomes in patients with COPD undergoing lung resection. Our objective was to evaluate the effects of a PRP on the VE/VCO2 slope in a cohort of patients with COPD undergoing lung resection for NSCLC. METHODS We retrospectively evaluated 25 consecutive patients with COPD participating in a three-week high-intensity PRP prior to undergoing lung surgery for NSCLC, between December of 2015 and January of 2017. Patients underwent complete functional assessment, including spirometry, DLCO measurement, and cardiopulmonary exercise testing. RESULTS There were no significant differences between the mean pre- and post-PRP values (% of predicted) for FEV1 (61.5 ± 22.0% vs. 62.0 ± 21.1%) and DLCO (67.2 ± 18.1% vs. 67.5 ± 13.2%). Conversely, there were significant improvements in the mean peak oxygen uptake (from 14.7 ± 2.5 to 18.2 ± 2.7 mL/kg per min; p < 0.001) and VE/VCO2 slope (from 32.0 ± 2.8 to 30.1 ± 4.0; p < 0.01). CONCLUSIONS Our results indicate that a high-intensity PRP can improve ventilatory efficiency in patients with COPD undergoing lung resection for NSCLC. Further comprehensive prospective studies are required to corroborate these preliminary results.
Collapse
Affiliation(s)
- Fabio Perrotta
- . Dipartimento di Medicina e Scienze della Salute V. Tiberio, Università degli Studi del Molise, Campobasso, Italia
| | - Antonio Cennamo
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | - Francesco Saverio Cerqua
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | | | - Andrea Bianco
- . Dipartimento di Scienze Mediche Traslazionali, Ospedale Monaldi. Università della Campania Luigi Vanvitelli Napoli, Italia
| | | | - Marco Rispoli
- . Dipartimento di Anestesia and Unità di Terapia Intensiva. A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Rosario Salvi
- . Dipartimento di Chirurgia Toracica. A.O. dei Colli, Ospedale Monaldi, Napoli, Italia
| | - Ilemando Meoli
- . Divisione di Pneumologia, Ospedale Monaldi, Napoli, Italia
| |
Collapse
|
20
|
Nagata M, Ito H, Yokose T, Tokushige A, Ueda S, Nakayama H. Effect of progressive sarcopenia during postoperative 6 months on long-term prognosis of completely resected lung cancer. J Thorac Dis 2019; 11:3411-3420. [PMID: 31559045 DOI: 10.21037/jtd.2019.08.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Preoperative sarcopenia has been indicated to be a potential prognostic factor for patients after complete resection of lung cancer. This study evaluated whether changes in the skeletal muscle mass index (SMI) over postoperative 6 months could predict long-term prognosis from 6 months after complete resection of non-small cell lung cancer (NSCLC). Methods This retrospective study analyzed data of 468 patients who underwent curative lobar resection for non-small cell lung cancer at our hospital. The 6-month postoperative change in SMI was calculated, and associations between clinicopathological factors (including the change in SMI) and postoperative mortality were examined. Results Rates of overall survival were 90.6% after 3 years and 80.7% after 5 years. The median 6-month change in SMI was -3.4% (range, -22.3% to 14.7%). Multivariate analysis revealed that poor outcomes were independently predicted by a large change in SMI, age, pathological stage, lymphovascular invasion, and a Brinkman index of ≥600. Through the analysis in training and validation sets, we determined a cut-off value of -9.9% for the 6-month postoperative change in SMI. Subgroup analysis showed that depletion of SMI during postoperative 6 months was a risk factor for poorer prognosis only in heavy smokers with a Brinkman index of ≥600. Conclusions A reduction in SMI during the 6 months after complete resection of non-small cell lung cancer significantly predicted prognosis, especially in heavy smokers. These results suggest that attention should be given to prevent the perioperative progression of sarcopenia after curative resection of lung cancer. Thoracic surgeons should take how to manage perioperatively against sarcopenia into consideration.
Collapse
Affiliation(s)
- Masashi Nagata
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan.,Department of General Surgery, Okinawa Kyodo Hospital, Naha, Japan.,Department of Clinical Research and Quality Management, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| | - Akihiro Tokushige
- Department of Clinical Research and Quality Management, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa, Japan
| | - Shinichiro Ueda
- Department of Clinical Research and Quality Management, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Asahi-ku, Yokohama, Japan
| |
Collapse
|
21
|
Hopkins RJ, Ko J, Gamble GD, Young RP. Airflow limitation and survival after surgery for non-small cell lung cancer: Results from a systematic review and lung cancer screening trial (NLST-ACRIN sub-study). Lung Cancer 2019; 135:80-87. [PMID: 31447006 DOI: 10.1016/j.lungcan.2019.07.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/11/2019] [Accepted: 07/16/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Lung cancer remains the single greatest cause of cancer mortality where surgery for early stage non-small cell lung cancer achieves the greatest survival. While there is growing optimism for better outcomes with screening using annual computed tomography, the impact of co-existing airflow limitation on survival remains unknown. To compare survival in non-small cell lung cancer patients undergoing surgery stratified according to the presence or absence of pre-surgery airflow limitation. MATERIALS AND METHODS We undertook a systematic literature search of non-screen lung cancer that encompassed studies reported between January 1946 and January 2017. Full-text articles were identified following eligibility scoring, with data extracted and analysed using a standardised analytical method (PRISMA). The results of this systematic review in non-screen lung cancers were compared to real-world results from a lung cancer screening cohort (N = 10,054), where outcomes following surgery could be compared after stratification according to pre-surgery airflow limitation. RESULTS In the systematic review, 6899 subjects were included from 10 studies; 7 were retrospective, 3 were prospective. Overall survival was 950 (44%) in 2144 people with COPD and 2597 (55%) from 4755 controls (unadjusted P value <0.001). However, the overall meta-analysed random effects odds ratio for overall survival (N = 10) and 5-year survival (N = 4) comparing those with and without COPD was 0.91 (95% CI = 0.84-1.00) and 0.99 (95% CI = 0.79-1.24) respectively. There were no signs of significant heterogeneity (I2 = 19.1%, P = 0.27) nor publication bias as assessed by funnel plot and Egger's test (P = 0.19). In the lung cancer screening sub-study of 10,054 screening participants we found no difference in 5-year survival in those with and without airflow limitation (84% and 81% respectively, P = 0.64). CONCLUSION Survival after surgery for non-small cell lung cancer is comparable between those with and without spirometry evidence of airflow limitation. This finding was replicated in lung cancer diagnosed during screening.
Collapse
Affiliation(s)
- R J Hopkins
- Faculty of Medical and Health Sciences University of Auckland, PO Box 37-971, Auckland, New Zealand
| | - J Ko
- Faculty of Medical and Health Sciences University of Auckland, PO Box 37-971, Auckland, New Zealand
| | - G D Gamble
- Faculty of Medical and Health Sciences University of Auckland, PO Box 37-971, Auckland, New Zealand
| | - R P Young
- Faculty of Medical and Health Sciences University of Auckland, PO Box 37-971, Auckland, New Zealand.
| |
Collapse
|
22
|
Wang P, Zhu M, Zhang D, Guo XG, Zhao S, Zhang XL, Wang DL, Liu CT. The relationship between chronic obstructive pulmonary disease and non-small cell lung cancer in the elderly. Cancer Med 2019; 8:4124-4134. [PMID: 31184445 PMCID: PMC6675702 DOI: 10.1002/cam4.2333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/19/2019] [Accepted: 05/24/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives Chronic obstructive pulmonary disease (COPD) and NSCLC often coexist and have poor prognoses, but studies investigating the impact of COPD on NSCLC have reported inconsistent findings. The objective of this study was to compare survival between NSCLC patients with and without COPD. Methods Medical records were retrospectively collected from 301 elderly patients pathologically diagnosed with NSCLC from the Chinese PLA General Hospital. Ultimately, a total of 200 patients were enrolled in the analysis. The survival rates between the COPD‐NSCLC and non‐COPD NSCLC were assessed using log‐rank and Cox proportional hazard regression analyses. Results A total of 117 COPD‐NSCLC and 93 non‐COPD NSCLC patients were enrolled in the analysis. The median overall survival times were 108.5 months in the non‐COPD group and 45.0 months in the COPD group (HR: 2.05; 95% CI, 1.36‐2.97, P = 0.0004). After 118 patients underwent propensity score matching, the median overall survival times were 100.6 months in the non‐COPD group and 51.9 months in the COPD group (HR: 1.59; 95% CI, 1.096‐2.64, P = 0.0459). The multivariate analysis showed that presence of COPD (HR 1.619, P = 0.030), old age (HR 1.007, P < 00001), an advanced disease stage (stage Ⅲ HR 5.513, P < 0.0001; stage Ⅳ HR 11.743, P < 0.0001), the squamous cell carcinoma histological subtype (HR 3.106, P < 0.0001), the presence of a cough (HR 2.463, P = 0.001) a higher serum carcinoembryonic antigen level (HR 1.001, P = 0.023) and higher NRL (HR 2.615, P = 0.007) were independent factors that were significantly associated with poorer survival. Conclusion A diagnosis of COPD had significant poorer survival outcomes in NSCLC than that of patients without COPD in this elderly population.
Collapse
Affiliation(s)
- Peng Wang
- Department of Medical Oncology, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Min Zhu
- Department of Medical Oncology, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Dong Zhang
- Department of Medical Oncology, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xue-Guang Guo
- Department of Medical Oncology, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shu Zhao
- Department of Medical Oncology, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Xue-Lin Zhang
- Department of Respiratory Diseases, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - De-Long Wang
- Department of Respiratory Diseases, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Chang-Ting Liu
- Department of Respiratory Diseases, The Second Medical Centre, Chinese People's Liberation Army General Hospital, Beijing, China
| |
Collapse
|
23
|
Lim JU, Yeo CD, Rhee CK, Kang HS, Park CK, Kim JS, Kim JW, Kim SJ, Yoon HK, Lee SH. Comparison of clinical characteristics and overall survival between spirometrically diagnosed chronic obstructive pulmonary disease (COPD) and non-COPD never-smoking stage I-IV non-small cell lung cancer patients. Int J Chron Obstruct Pulmon Dis 2019; 14:929-938. [PMID: 31118602 PMCID: PMC6503336 DOI: 10.2147/copd.s190244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 03/18/2019] [Indexed: 11/23/2022] Open
Abstract
Objectives: A significant proportion of non-small cell lung cancer (NSCLC) patients are never-smokers. However, the clinical impact of spirometrically diagnosed chronic obstructive pulmonary disease (COPD) on the prognosis of never-smoking NSCLC has not been evaluated in the context of treatment modalities and other cancer-related factors. In the present study, we evaluated the clinical impact of COPD in non-smoking NSCLC patients, and correlations between COPD and other previously unevaluated clinical variables. Materials and methods: Lung cancer patients (stages I to IV) diagnosed with NSCLC between January 2008 and December 2015 at six university hospitals were enrolled in the study cohort and retrospectively evaluated. Clinical parameters were compared between spirometrically diagnosed COPD and non-COPD groups. Correlations between COPD status and other variables were evaluated. In order to reduce the effect of potential confounders and selection bias, we performed adjustment for differences in baseline parameters by using propensity score matching (PSM). After PSM, clinical variables were evaluated for their effects on overall survival (OS). Results: Of the 345 patients enrolled in the study, 277 were categorized as non-COPD and 68 as COPD. Old age, male gender, and wild-type EGFR were significantly correlated with COPD. By univariate analysis of 218 patients in a propensity score matched cohort, not receiving active anticancer treatment, advanced stage, and COPD were significantly associated with shorter OS. Multivariate analysis showed that not receiving active anticancer treatment, advanced cancer stage, and COPD (P=0.044, HR: 1.526, 95% CI: 1.012–2.300) were significant predictors of shorter OS. Conclusion: In the present study, never-smoker NSCLC patients with COPD had shorter OS times, compared to non-COPD never-smoker NSCLC patients.
Collapse
Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chin Kook Rhee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyoung Kyu Yoon
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
24
|
Lin H, Lu Y, Lin L, Meng K, Fan J. Does chronic obstructive pulmonary disease relate to poor prognosis in patients with lung cancer?: A meta-analysis. Medicine (Baltimore) 2019; 98:e14837. [PMID: 30882673 PMCID: PMC6426564 DOI: 10.1097/md.0000000000014837] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Nowadays, there is growing recognition that chronic obstructive pulmonary disease (COPD) may have influence on lung cancer. However, coexisted COPD related to prognosis of lung cancer is still elusive. We conducted this meta-analysis to examine the association between COPD and 5-year overall survival (OS) and postoperative pulmonary complications of patients with lung cancer. METHODS A comprehensive computer-based online search was conducted using PubMed, Embase, Medline, and the Cochrane Library for articles published before September 30, 2017. We identified 29 eligible studies, which included 70,111 patients in the related literature. RESULTS Twenty-two of the 29 studies provided hazard ratio for OS (1.18, 95% confidence interval: 1.11-1.25; P < .001), it suggested that the presence of COPD indicated poor survival for the patients with lung cancer. In subgroup analysis, the relationship between COPD and OS occurrence remained statistically prominent in the subgroups stratified by study designs, COPD diagnosis timing, lung cancer surgery, cancer stage, and origins of patients. The presence of COPD increased the risk of bronchopleural fistula, pneumonia, prolonged air leakage, and prolonged mechanical ventilation. CONCLUSIONS The present meta-analysis suggested that coexisting COPD is associated with poor survival outcomes in patients with lung cancer and higher rates of postoperative pulmonary complications.
Collapse
Affiliation(s)
- Hefeng Lin
- The Second Affiliated Hospital, School of Medicine
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Yunlong Lu
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Liya Lin
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Meng
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Junqiang Fan
- The Second Affiliated Hospital, School of Medicine
| |
Collapse
|
25
|
Wang W, Dou S, Dong W, Xie M, Cui L, Zheng C, Xiao W. Impact of COPD on prognosis of lung cancer: from a perspective on disease heterogeneity. Int J Chron Obstruct Pulmon Dis 2018; 13:3767-3776. [PMID: 30538439 PMCID: PMC6251360 DOI: 10.2147/copd.s168048] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background COPD is an important comorbidity of lung cancer, but the impact of COPD on the outcomes of lung cancer remains uncertain. Because both COPD and lung cancer are heterogeneous diseases, we evaluated the link between COPD phenotypes and the prognosis of different histological subtypes of lung cancer. Methods In this retrospective study, subjects with a newly and pathologically confirmed diagnosis of lung cancer were enrolled from patients preparing for lung cancer surgery. All participants underwent pulmonary function test (PFT). The diagnosis of COPD was based on GOLD criteria. Lung cancer subtypes and COPD phenotypes were categorized by WHO classification of lung tumors and computer quantitative analysis of PFT. The HRs were estimated by Cox regression analysis. Results Among 2,222 lung cancer patients, 32.6% coexisted with COPD. After adjustment for age, sex, body mass index (BMI), smoking status, and therapy method, COPD was significantly associated with the decreased overall survival (OS) of lung cancer (HR 1.28, 95% CI 1.05-1.57). With the increased severity of COPD, the OS of lung cancer was gradually worsened (HR 1.23, 95% CI 1.08-1.39). But surgical treatment and high BMI were independent prognostic protective factors (HR 0.46, 95% CI 0.37-0.56; HR 0.96, 95% CI 0.94-0.99). Moreover, in terms of disease heterogeneity, emphysema-predominant phenotype of COPD was an independent prognostic risk factor for squamous carcinoma (HR 2.53, 95% CI 1.49-4.30). No significant relationship between COPD phenotype and lung cancer prognosis was observed among adenocarcinoma, small cell lung cancer, large cell lung cancer, and other subtype patients. Conclusion These findings suggest that COPD, especially emphysema-predominant phenotype, is an independent prognostic risk factor for squamous carcinoma only.
Collapse
Affiliation(s)
- Wei Wang
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China, ,
| | - Shuang Dou
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China, ,
| | - Wenyan Dong
- Department of Geriatric Medicine, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Mengshuang Xie
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China, ,
| | - Liwei Cui
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China, ,
| | - Chunyan Zheng
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China, ,
| | - Wei Xiao
- Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, People's Republic of China, ,
| |
Collapse
|
26
|
Yi YS, Ban WH, Sohng KY. Effect of COPD on symptoms, quality of life and prognosis in patients with advanced non-small cell lung cancer. BMC Cancer 2018; 18:1053. [PMID: 30373585 PMCID: PMC6206922 DOI: 10.1186/s12885-018-4976-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 10/19/2018] [Indexed: 01/15/2023] Open
Abstract
Background Many studies have reported the prevalence of chronic obstructive pulmonary disease (COPD) and its effects and prognosis in patients with lung cancer, but few have considered quality of life and survival of patients with lung cancer according to severity of airway obstruction. This study investigated the presence of COPD and the severity of airway obstruction in patients with non-small cell lung cancer (NSCLC), and analyzed how these factors affected symptoms, quality of life, and prognosis. Methods We retrospectively reviewed the prospective lung cancer database of the Catholic Medical Centers at the Catholic University of Korea from 2014 to 2017. We enrolled patients with advanced NSCLC and evaluated quality of life using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. We also estimated pulmonary function and analyzed survival data. Results Of the 337 patients with advanced NSCLC, 170 (50.5%) had COPD and 167 (49.5%) did not. Significant differences were observed in symptoms between the two groups. The COPD group complained of more symptoms, such as cough, sputum, and dyspnea, than those in the non-COPD group. The distribution according to the severity of obstruction in the COPD group was as follows: Grade 1 (FEV1 ≥ 80%) 35 patients (20.6%), Grade 2 (50% ≤ FEV1 < 80%) 103 patients (60.6%), Grade 3 (30% ≤ FEV1 < 50%) 24 patients (14.1%), and Grade 4 (FEV1 < 30%) 8 patients (4.7%). The presence of COPD did not affect overall quality of life in patients with NSCLC, but as the airway obstruction increased, physical function decreased, and fatigue and dyspnea were more frequent. The overall median survival of the COPD group was shorter than that of the non-COPD group (median survival, 224 vs. 339 days, p = 0.035). Conclusions In this study, a high prevalence of COPD was found among patients with advanced NSCLC, and COPD patients complained about various symptoms and had diminished quality of life in several sectors. Therefore, it is necessary to actively evaluate quality of life, lung function, and symptoms in patients with lung cancer and reflect them in the treatment and management plans of these patients.
Collapse
Affiliation(s)
- Young-Soo Yi
- Doctoral candidate, The Catholic University of Korea, Seoul, South Korea
| | - Woo Ho Ban
- Division of pulmonary, Critical Care and sleep Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyeong-Yae Sohng
- Department of Nursing, College of Nursing, The Catholic University of Korea, Seoul, South Korea.
| |
Collapse
|
27
|
Ju S, Lee HR, Kim J, Kim HC, Lee G, You JW, Cho YJ, Jeong YY, Lee JD, Lee SJ. Impact of coexistent chronic obstructive pulmonary disease on the survival of patients with small cell lung cancer receiving chemotherapy. Thorac Cancer 2018; 9:1271-1278. [PMID: 30109781 PMCID: PMC6166064 DOI: 10.1111/1759-7714.12832] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND While there is growing interest in the correlation between chronic obstructive pulmonary disease (COPD) and non-small cell lung cancer, very few studies have examined the interaction between COPD and small cell lung cancer (SCLC). Therefore, the aim of this study was to examine the impact of COPD on the survival of patients with SCLC. METHODS The medical records of 110 patients with SCLC who received chemotherapy from July 2006 until April 2014 were retrospectively examined. The overall survival (OS) and progression-free survival (PFS) rates of spirometry-diagnosed COPD and non-COPD groups were compared. Predictors for poorer survival were analyzed using Cox proportional hazards regression. RESULTS Of the 110 SCLC patients, 57 (51.8%) had coexistent COPD. The median OS for the COPD group was 11.6 months and for the non-COPD group was 11.2 months (log-rank test, P = 0.581), whereas the median PFS rates were 6.65 and 6.57 months, respectively (log-rank test, P = 0.559). Multivariate analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 and extensive-stage SCLC as independent risk factors for shorter OS; however, coexisting COPD was not a predictor of survival. CONCLUSIONS Although over half of the SCLC patients receiving chemotherapy had COPD, coexisting COPD had no impact on the survival of patients with SCLC.
Collapse
Affiliation(s)
- Sunmi Ju
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Hyang Rae Lee
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Ju‐Young Kim
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Changwon Hospital, Changwon, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Ho Cheol Kim
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Changwon Hospital, Changwon, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Gyeong‐Won Lee
- Hematology and Oncology Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Jung Wan You
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Yu Ji Cho
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Yi Yeong Jeong
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Jong Deog Lee
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| | - Seung Jun Lee
- Pulmonology and Allergy Division, Department of Internal MedicineGyeongsang National University Hospital, Gyeongsang National University School of MedicineJinjuSouth Korea
| |
Collapse
|
28
|
Lim JU, Yeo CD, Rhee CK, Kim YH, Park CK, Kim JS, Kim JW, Kim SJ, Yoon HK, Lee SH. Overall survival of driver mutation-negative non-small cell lung cancer patients with COPD under chemotherapy compared to non-COPD non-small cell lung cancer patients. Int J Chron Obstruct Pulmon Dis 2018; 13:2139-2146. [PMID: 30034229 PMCID: PMC6047599 DOI: 10.2147/copd.s167372] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives Focusing on the advanced non-small cell lung cancer (NSCLC) patients without driver mutations can elucidate the clinical impact of COPD on treatment outcomes. The present study evaluated the effects of COPD on the overall survival of driver mutation-negative NSCLC patients undergoing conventional chemotherapy as the first-line treatment. Patients and methods Medical records of stage IIIB and IV NSCLC patients from January 2008 to December 2015 from six university hospitals were reviewed. Results The total study population consisted of 197 patients; 92 (46.7%) were COPD patients and 105 (53.3%) were non-COPD patients. The median survival in the non-COPD group was 11.5 months, compared to 9.2 months in the COPD group. Univariate analysis showed that old age (>70 years), high Eastern Cooperative Oncology Group status score (2–3), squamous cell histology, and COPD were risk factors for mortality. The presence of COPD was a significant prognostic factor in univariate analysis (hazard ratio [HR], 1.402; p=0.037), but not in multivariate analysis (HR, 1.275; p=0.144). Subgroup analysis of 143 smokers showed that COPD was a significant prognostic factor on multivariate analysis (HR, 1.726; p=0.006). In 154 stage IV patients, COPD was also a prognostic factor in multivariate analysis (HR, 1.479; p=0.039). Conclusion COPD had a negative impact on overall survival in the stage IV NSCLC and smoker NSCLC patients who underwent conventional chemotherapy.
Collapse
Affiliation(s)
- Jeong Uk Lim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Chang Dong Yeo
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Chin Kook Rhee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Yong Hyun Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Chan Kwon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Ju Sang Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Jin Woo Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Seung Joon Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Hyoung Kyu Yoon
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| | - Sang Haak Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea,
| |
Collapse
|
29
|
Qiang G, Yu Q, Liang C, Song Z, Shi B, Guo Y, Liu D. [Impact of Chronic Obstructive Pulmonary Disease on Risk of Recurrence in Patients with Resected Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2018; 21:215-220. [PMID: 29587946 PMCID: PMC5973041 DOI: 10.3779/j.issn.1009-3419.2018.03.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Lung cancer and chronic obstructive pulmonary disease (COPD) are both common diseases in respiratory system and the leading causes of deaths worldwide. The purpose of this study was to determine whether the severity of COPD affects long-term survival in non-small cell lung cancer (NSCLC) patients after surgical resection. METHODS A retrospective research was performed on 421 consecutive patients who had undergone lobectomy for NSCLC. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed. RESULTS A total of 172 patients were diagnosed with COPD, 124 as mild (GOLD-1), 46 as moderate(GOLD-2), and 2 as severe (GOLD-3). The frequencies of recurrence were significantly higher in higher COPD grades group (P<0.001). Recurrence-free survival at five years were 78.1%, 70.4%, and 46.4% in Non-COPD, GOLD-1 COPD, and GOLD-2/3 COPD groups, respectively (P<0.001). In univariate analysis, age, gender, smoking history, COPD severity, tumor size, histology and pathological stage were associated with recurrence-free survival. Multivariate analyses showed that older age, male, GOLD-2/3 COPD, and advanced stage were independent risk factors associated with recurrence-free survival. CONCLUSIONS NSCLC patients with COPD are at higher risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor. The severity of COPD based on pulmonary function test can be a useful indicator to identify patients at high risk for recurrence. Therefore, it can contribute to adequate selection of the appropriate individualized treatment.
Collapse
Affiliation(s)
- Guangliang Qiang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Qiduo Yu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Zhiyi Song
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Bin Shi
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing 100029, China
| |
Collapse
|
30
|
Cho O, Oh YT, Chun M, Noh OK, Heo JS. Prognostic implication of FEV1/FVC ratio for limited-stage small cell lung cancer. J Thorac Dis 2018; 10:1797-1805. [PMID: 29707334 DOI: 10.21037/jtd.2018.02.14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background A proportion of patients with chronic obstructive pulmonary disease (COPD) may progress rapidly to small cell lung cancer (SCLC). As the forced expiratory volume in 1 second (FEV1)/forced volume vital capacity (FVC) ratio is usually impaired in patients with COPD, and given that the FEV1 and FVC are not necessarily related to lung cancer development, we performed this study to test our hypothesis that the FEV1/FVC ratio predicts survival of patients with limited-stage (LS)-SCLC. Methods We assessed 74 patients with LS-SCLC treated with chemoradiotherapy. The patients were divided into two FEV1/FVC ratio groups: <0.74 (n=24) and ≥0.74 (n=50). Results The 3-year overall survival (OS) and 3-year progression-free survival (PFS) rates were significantly lower in patients with FEV1/FVC <0.74 than in those with FEV1/FVC ≥0.74 group (35.4% vs. 61.2%, P=0.0033; and 11.7% vs. 51.8%, P=0.0072, respectively). On multivariate analysis, the low FEV1/FVC group was independently associated with OS and PFS [hazard ratio (HR) (95% confidence interval): 2.15 (0.99-4.63), P=0.052; and 2.13 (1.04-4.39), P=0.039, respectively]. Conclusions Pretreatment FEV1/FVC ratio appears to be a potential prognostic factor for patients with LS-SCLC.
Collapse
Affiliation(s)
- Oyeon Cho
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Young-Taek Oh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Mison Chun
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - O Kyu Noh
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Sung Heo
- Department of Radiation Oncology, Ajou University School of Medicine, Suwon, Korea
| |
Collapse
|
31
|
Rios J, Gosain R, Goulart BH, Huang B, Oechsli MN, McDowell JK, Chen Q, Tucker T, Kloecker GH. Treatment and outcomes of non-small-cell lung cancer patients with high comorbidity. Cancer Manag Res 2018; 10:167-175. [PMID: 29416376 PMCID: PMC5789001 DOI: 10.2147/cmar.s151935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background The life expectancy of untreated non-small-cell lung cancer (NSCLC) is dismal, while treatment for NSCLC improves survival. The presence of comorbidities is thought to play a significant role in the decision to treat or not treat a given patient. We aim to evaluate the association of comorbidities with the survival of patients treated for NSCLC. Methods We performed a retrospective study of patients aged ≥66 years with invasive NSCLC between the years 2007 and 2011 in the Surveillance, Epidemiology, and End Results Kentucky Cancer Registry. Comorbidity was measured using the Klabunde Comorbidity Index (KCI), and univariate and multivariate logistic regression models were used to measure association between receiving treatment and comorbidity. Kaplan–Meier plots were constructed to estimate time-to-event outcomes. Results A total of 4014 patients were identified; of this, 94.9% were white and 55.7% were male. The proportion of patients who did not receive any treatment was 8.7%, 3.9%, 19.1%, and 23.5% for stages I, II, III, and IV, respectively (p<0.0001). In multivariate analysis, older age, higher stage, and higher comorbidity (KCI ≥3) were associated with a lower likelihood of receiving any treatment. The median overall survival (OS) for untreated and KCI=0 was 17.7 months for stages I and II, 2.3 months for stage III, and 1.3 months for stage IV. The median OS for treated and KCI=0 was 58.9 months for stages I and II, 16.8 months for stage III, and 5.8 months for stage IV (p<0.01). Treatment was an independent predictor of OS in multivariate analysis that included KCI scores. Conclusion Our data suggest that lung cancer patients may derive a survival benefit from therapies, regardless of the presence of comorbidities, although the degree of benefit seems to decrease with higher KCI scores.
Collapse
Affiliation(s)
- Jorge Rios
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Rahul Gosain
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | - Bernardo Hl Goulart
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA
| | - Bin Huang
- Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, KY
| | - Margaret N Oechsli
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| | | | - Quan Chen
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Thomas Tucker
- Markey Cancer Center, University of Kentucky, Lexington, KY, USA
| | - Goetz H Kloecker
- James Graham Brown Cancer Center, University of Louisville, Louisville, KY
| |
Collapse
|
32
|
Omote N, Hashimoto N, Morise M, Sakamoto K, Miyazaki S, Ando A, Nakahara Y, Hasegawa Y. Impact of mild to moderate COPD on feasibility and prognosis in non-small cell lung cancer patients who received chemotherapy. Int J Chron Obstruct Pulmon Dis 2017; 12:3541-3547. [PMID: 29270008 PMCID: PMC5729822 DOI: 10.2147/copd.s149456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Non-small cell lung cancer (NSCLC) is the predominant cause of death in patients with COPD, and the severity of COPD in NSCLC patients is classified mainly as mild to moderate. Most advanced NSCLC patients with mild to moderate COPD are treated with chemotherapy; however, the feasibility for and prognosis after chemotherapy of these patients are not well understood. The aim of this study was to elucidate the impact of mild to moderate COPD on the feasibility for and prognosis after chemotherapy in NSCLC patients. Patients and methods A retrospective review was performed on 268 NSCLC patients who received first-line chemotherapy from 2009 to 2014 in our institution. Finally, 85 evaluable patients were included in this study. The clinical characteristics, toxicity profile, objective response rate, and prognosis were analyzed and compared between patients with mild to moderate COPD and those without COPD (non-COPD). Results Forty-three patients were classified as COPD (27 cases mild and 16 cases moderate) and 42 patients as non-COPD. The COPD group were older and had fewer never-smokers than the non-COPD group. The objective response rate did not differ between groups (p=0.14). There was no significant difference in overall survival between COPD and non-COPD groups (15.0 and 17.0 months, log-rank test p=0.57). In the multivariate Cox's proportional hazard model, the adjusted hazard ratio (HRadj) was statistically significant for male sex (HRadj =5.382, 95% CI: 1.496-19.359; p=0.010), pathological diagnosis of adenocarcinoma (HRadj =0.460, 95% CI: 0.223-0.948; p=0.035), and epithelial growth factor receptor negative mutation (HRadj =6.040, 95% CI: 1.158-31.497; p=0.033), but not for the presence of COPD (HRadj =0.661, 95% CI: 0.330-1.325; p=0.24). Toxicity profile in COPD group was favorable, as in the non-COPD group. Conclusion Mild to moderate COPD did not have a significant deleterious impact on toxicity and prognosis in NSCLC patients.
Collapse
Affiliation(s)
- Norihito Omote
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naozumi Hashimoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahiro Morise
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Sakamoto
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinichi Miyazaki
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akira Ando
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshio Nakahara
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Hasegawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
33
|
Tao H, Soh J, Yamamoto H, Fujiwara T, Ueno T, Hayama M, Okazaki M, Sugimoto R, Yamashita M, Sano Y, Okabe K, Matsuura M, Kataoka K, Moriyama S, Toyooka S, Miyoshi S. Restrictive ventilatory impairment is associated with poor outcome in patients with cT1aN0M0 peripheral squamous cell carcinoma of the lung. J Thorac Dis 2017; 9:4325-4335. [PMID: 29268501 DOI: 10.21037/jtd.2017.10.70] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Patients with squamous cell carcinoma (SqCC) of the lung sometimes have a comorbid pulmonary disease such as pulmonary emphysema or an interstitial lung disease (ILD), both of which negatively affect patient outcome. The aim of this study was to determine the outcome of patients in a multicenter database who underwent surgery for cT1aN0M0 peripheral SqCC lung cancer. Methods The medical records of a total of 228 eligible patients from seven institutions were reviewed to evaluate the impact of concomitant impaired pulmonary function and other clinicopathological factors on overall survival (OS) and relapse-free survival (RFS). Results Six patients with positive or unclear tumor margins were excluded. Of the 222 remaining study patients, 42 (18.9%) and 97 (43.7%) patients were found to have coexisting restrictive or obstructive ventilatory impairment, respectively. Over a median follow-up period of 30.6 months, the 5-year OS and RFS were 69.0% and 62.6%, respectively. By multivariate analysis, ILDs identified on high-resolution computed tomography (HRCT), pulmonary function test results indicating a restrictive ventilatory impairment, and wedge resection were found to be independent risk factors for poor OS. An increased level of serum squamous cell carcinoma antigen (SCC-Ag) (>1.5 ng/mL) and the same risk factors for poor OS were independent risk factors for recurrence. Among patients who underwent anatomical lung resection (lobectomy and segmentectomy, n=173), a restrictive ventilatory impairment was an independent risk factor for poor OS, and increased serum SCC-Ag level, ILDs on HRCT, and restrictive ventilatory impairment were independent risk factors for poor RFS by multivariate analysis. Factors such as visceral pleural invasion, and lymphatic or vascular invasion were not significantly associated with outcome. Conclusions A restrictive ventilatory impairment negatively affects the outcome of patients with cT1aN0M0 peripheral SqCC lung cancer.
Collapse
Affiliation(s)
- Hiroyuki Tao
- Division of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - Junichi Soh
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Hiromasa Yamamoto
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| | - Toshiya Fujiwara
- Department of Thoracic Surgery, Hiroshima City Hospital, Hiroshima, Japan
| | - Tsuyoshi Ueno
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Makio Hayama
- Department of Thoracic Surgery, Okayama Red Cross General Hospital, Okayama, Japan
| | - Mikio Okazaki
- Center of Chest Medicine and Surgery, Ehime University, Toon, Japan
| | - Ryujiro Sugimoto
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan.,Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Motohiro Yamashita
- Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Yoshifumi Sano
- Center of Chest Medicine and Surgery, Ehime University, Toon, Japan
| | - Kazunori Okabe
- Division of Thoracic Surgery, National Hospital Organization Yamaguchi-Ube Medical Center, Ube, Japan
| | - Motoki Matsuura
- Department of Thoracic Surgery, Hiroshima City Hospital, Hiroshima, Japan
| | - Kazuhiko Kataoka
- Department of Thoracic Surgery, National Hospital Organization Iwakuni Clinical Center, Iwakuni, Japan
| | - Shigeharu Moriyama
- Department of Thoracic Surgery, Okayama Red Cross General Hospital, Okayama, Japan
| | - Shinichi Toyooka
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan.,Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Shinichiro Miyoshi
- Department of Thoracic Surgery, Okayama University Hospital, Okayama, Japan
| |
Collapse
|
34
|
Dai J, Yang P, Cox A, Jiang G. Lung cancer and chronic obstructive pulmonary disease: From a clinical perspective. Oncotarget 2017; 8:18513-18524. [PMID: 28061470 PMCID: PMC5392346 DOI: 10.18632/oncotarget.14505] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 12/27/2016] [Indexed: 12/18/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ping Yang
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Minnesota, United States of America
| | - Angela Cox
- Department of Oncology, University of Sheffield Medical School, Sheffield, United Kingdom
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| |
Collapse
|
35
|
王 鹏, 张 东, 郭 学, 孙 宝, 方 向, 曲 歌, 刘 长. [Clinical characteristics and risk factors affecting outcomes of elderly patients with non-small cell lung cancer complicated by chronic obstructive pulmonary disease]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2017; 37:889-894. [PMID: 28736363 PMCID: PMC6765511 DOI: 10.3969/j.issn.1673-4254.2017.07.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To investigate the clinical features, treatment strategy and risk factors affecting the prognosis of elderly patients with non-small cell lung cancer (NSCLC) complicated by chronic obstructive pulmonary disease (COPD). METHODS We retrospectively analyzed the data of elderly patietns (>60 years) with newly diagnosed NSCLC complicated by COPD at the Geriatric Institution of General Hospital of PLA between January, 2000 and June, 2015. The clinical data collected included history of smoking, pulmonary function test results, initial treatments, TNM stage, chief complaints, comorbidities and laboratory tests. The Cox proportional hazards regression model was used to explore the prognostic factors in these patients. RESULTS A total of 200 NSCLC patients were reviewed, of which 107 (53.5%) patients had the co-morbidity of COPD as confirmed by spirometry using bronchodilator test. The median survival of the patients with NSCLC complicated by COPD was 45.8 months with 1-, 3-, 5-, and 10-year survival rates of 80.4%, 55.4%, 41.0% and 20.0%, respectively. Stratification analysis showed that patients with COPD Gold grades 1 and 2 had a significant longer median overall survival (51.7 and 43.1 months, respectively) than those with grade 3/4 (16.9 months; P=0.020 and 0.043, respectively). Univariate and multivariate analyses using Cox proportional hazards regression model showed that an older age, a higher Gold grade, advanced disease stage (stages III and IV), squamous cell carcinoma, nonsurgical initial treatment, coughing and an elevated serum CEA level were independent risk factors for shorter survival of the patients. CONCLUSION Multiple prognostic factors can affect the outcomes of elderly patients with NSCLC complicated by COPD, and a higher COPD Gold grade that fails to respond to treatment within 3 months is the independent risk factor for survival of the patients.
Collapse
Affiliation(s)
- 鹏 王
- 中国人民解放军总医院南楼临床部 肿瘤内科,北京 100853Department of Nanlou Medical Oncology, General Hospital of PLA, Beijing 100853, China
| | - 东 张
- 中国人民解放军总医院南楼临床部 肿瘤内科,北京 100853Department of Nanlou Medical Oncology, General Hospital of PLA, Beijing 100853, China
| | - 学光 郭
- 中国人民解放军总医院南楼临床部 肿瘤内科,北京 100853Department of Nanlou Medical Oncology, General Hospital of PLA, Beijing 100853, China
| | - 宝君 孙
- 中国人民解放军总医院南楼临床部 呼吸内科,北京 100853Department of Nanlou Respiratory Diseases, General Hospital of PLA, Beijing 100853, China
| | - 向群 方
- 中国人民解放军总医院南楼临床部 呼吸内科,北京 100853Department of Nanlou Respiratory Diseases, General Hospital of PLA, Beijing 100853, China
| | - 歌平 曲
- 中国人民解放军总医院南楼临床部 呼吸内科,北京 100853Department of Nanlou Respiratory Diseases, General Hospital of PLA, Beijing 100853, China
| | - 长庭 刘
- 中国人民解放军总医院南楼临床部 呼吸内科,北京 100853Department of Nanlou Respiratory Diseases, General Hospital of PLA, Beijing 100853, China
| |
Collapse
|
36
|
Wang J, Xu H, Zhou S, Wang D, Zhu L, Hou J, Tang J, Zhao J, Zhong S. Body mass index and mortality in lung cancer patients: a systematic review and meta-analysis. Eur J Clin Nutr 2017; 72:4-17. [PMID: 28513621 DOI: 10.1038/ejcn.2017.70] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/04/2017] [Accepted: 04/12/2017] [Indexed: 01/19/2023]
Abstract
Studies examining the relation of body mass index (BMI) and mortality in patients with lung cancer have shown diverse results. We conducted a meta-analysis to investigate the association using all available studies from January 1982 to October 2016. PubMed and EMBASE were searched to identify relevant studies. We calculated the summary hazard ratio (HR) and 95% confidence interval (CI) using random effects model. The dose-response relationship was assessed by random effects meta-regression model. Fifty-five articles from 51 studies involving 3 152 552 subjects (males, 54.8%) were included. The pooled results suggested that on average a high BMI decreased risk of death from lung cancer or all-cause. Each 5 kg/m2 increase in BMI had a 12% lower risk of lung cancer-specific mortality (HR=0.88, 95% CI: 0.75-1.02, P=0.09) and a 14% lower risk of all-cause mortality (HR=0.86, 95% CI: 0.77-0.96, P<0.01). When stratifying by ethnicity, each 5 kg/m2 increase in BMI was associated with 22% and 28% reduction, respectively, in the risk of lung cancer-specific mortality (P<0.01) and all-cause mortality (P<0.01) in Asians, but no association was found in Westerners (P=0.51 and P=0.53, respectively). In conclusion, lung cancer patients with a higher BMI have a longer survival than those with a lower BMI. Considering the significant heterogeneity between included studies, future studies are needed to confirm these findings.
Collapse
Affiliation(s)
- J Wang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.,Department of General Surgery, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - H Xu
- Department of Radiation Oncology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China
| | - S Zhou
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - D Wang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - L Zhu
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - J Hou
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - J Tang
- Department of General Surgery, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - J Zhao
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.,Center of Clinical Laboratory Science, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| | - S Zhong
- Center of Clinical Laboratory Science, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research, Nanjing, China.,Center of Clinical Laboratory Science, Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China
| |
Collapse
|
37
|
Nagata M, Ito H, Matsuzaki T, Furumoto H, Isaka T, Nishii T, Yokose T, Nakayama H. Body mass index, C-reactive protein and survival in smokers undergoing lobectomy for lung cancer†. Eur J Cardiothorac Surg 2017; 51:1164-1170. [DOI: 10.1093/ejcts/ezx004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/23/2016] [Indexed: 12/13/2022] Open
|
38
|
Bülbül Y, Ozlu T, Arinc S, Ozyurek B, Gunbatar H, Senturk A, Bahadir A, Ozcelik M, Yilmaz U, Akbay M, Saglam L, Kilic T, Kirkil G, Ozcelik N, Tatar D, Baris S, Yavsan D, Sen H, Berk S, Acat M, Cakmak G, Yumuk P, Intepe Y, Toru U, Ayik S, Basyigit I, Ozkurt S, Mutlu L, Yasar Z, Esme H, Erol M, Oruc O, Erdoğan Y, Asker S, Ulas A, Erol S, Kerget B, Erbaycu A, Teke T, Beşiroğlu M, Can H, Dalli A, Talay F. Assessment of Palliative Care in Lung Cancer in Turkey. Med Princ Pract 2017; 26:50-56. [PMID: 27780164 PMCID: PMC5588338 DOI: 10.1159/000452801] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 10/24/2016] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.
Collapse
Affiliation(s)
- Y. Bülbül
- Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Izmir, Turkey
| | - T. Ozlu
- Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Izmir, Turkey
| | - S. Arinc
- Department of Chest Diseases, School of Medicine, Sureyyapasa, Istanbul, Turkey
| | - B.A. Ozyurek
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara, Turkey
| | - H. Gunbatar
- Department of Chest Diseases, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - A. Senturk
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara
| | - A. Bahadir
- Department of Chest Diseases, School of Medicine, Yedikule, Istanbul, Turkey
| | - M. Ozcelik
- Department of Chest Diseases, School of Medicine, Kartal, Istanbul
| | - U. Yilmaz
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
- *Prof. Yilmaz Bülbül, Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Farabi Cd. No: 66, TR–61080 Trabzon (Turkey), E-Mail
| | - M.O. Akbay
- Department of Chest Diseases, School of Medicine, Sureyyapasa, Istanbul, Turkey
| | - L. Saglam
- Department of Chest Diseases, School of Medicine, Ataturk University, Erzurum, Turkey
| | - T. Kilic
- Department of Chest Diseases, School of Medicine, Inonu University, Malatya, Turkey
| | - G. Kirkil
- Department of Chest Diseases, School of Medicine, Firat University, Elazıg, Turkey
| | - N. Ozcelik
- Department of Chest Diseases, School of Medicine, Karadeniz Technical University, Trabzon, Izmir, Turkey
| | - D. Tatar
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
| | - S.A. Baris
- Department of Chest Diseases, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - D.M. Yavsan
- Department of Chest Diseases, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - H.S. Sen
- Department of Chest Diseases, School of Medicine, Dicle University, Diyarbakir, Turkey
| | - S. Berk
- Department of Chest Diseases, School of Medicine, Cumhuriyet University, Sivas, Turkey
| | - M. Acat
- Department of Chest Diseases, School of Medicine, Karabük University, Karabük, Turkey
| | - G. Cakmak
- Department of Chest Diseases, School of Medicine, Haseki, Istanbul
| | - P.F. Yumuk
- Department of Chest Diseases, School of Medicine, Department of Medical Oncology School of Medicine, Marmara University, Istanbul, Izmir, Turkey
| | - Y.S. Intepe
- Department of Chest Diseases, School of Medicine, Bozok University, Yozgat, Turkey
| | - U. Toru
- Department of Chest Diseases, School of Medicine, Dumlupinar University, Kutahya, Turkey
| | - S.O. Ayik
- Department of Chest Diseases, School of Medicine, Katip Celebi University, Izmir, Turkey
| | - I. Basyigit
- Department of Chest Diseases, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - S. Ozkurt
- Department of Chest Diseases, School of Medicine, Pamukkale University, Denizli, Turkey
| | - L.C. Mutlu
- Department of Chest Diseases, School of Medicine, Namik Kemal University, Tekirdag, Turkey
| | - Z.A. Yasar
- Department of Chest Diseases, School of Medicine, Abant Izzet Baysal University, Bolu, Pulmonary Diseases and Thoracic Surgery Education and Research Hospitals of, Izmir, Turkey
| | - H. Esme
- Department of Chest Diseases, School of Medicine, Konya, Konya
| | - M.M. Erol
- Department of Chest Diseases, School of Medicine, Department of Thoracic Surgery School of Medicine, Uludag University, Bursa, Turkey
| | - O. Oruc
- Department of Chest Diseases, School of Medicine, Sureyyapasa, Istanbul, Turkey
| | - Y. Erdoğan
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara, Turkey
| | - S. Asker
- Department of Chest Diseases, School of Medicine, Yuzuncu Yil University, Van, Turkey
| | - A. Ulas
- Department of Chest Diseases, School of Medicine, Ataturk, Ankara
| | - S. Erol
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
| | - B. Kerget
- Department of Chest Diseases, School of Medicine, Ataturk University, Erzurum, Turkey
| | - A.E. Erbaycu
- Department of Chest Diseases, School of Medicine, Dr. Suat Seren, Izmir, Education and Research Hospitals of, Izmir, Turkey
| | - T. Teke
- Department of Chest Diseases, School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - M. Beşiroğlu
- Department of Chest Diseases, School of Medicine, Department of Medical Oncology School of Medicine, Marmara University, Istanbul, Izmir, Turkey
| | - H. Can
- Department of Chest Diseases, School of Medicine, Department of Family Medicine School of Medicine, Katip Celebi University, Izmir, Turkey
| | - A. Dalli
- Department of Chest Diseases, School of Medicine, Katip Celebi University, Izmir, Turkey
| | - F. Talay
- Department of Chest Diseases, School of Medicine, Abant Izzet Baysal University, Bolu, Pulmonary Diseases and Thoracic Surgery Education and Research Hospitals of, Izmir, Turkey
| |
Collapse
|
39
|
Young RP, Duan F, Chiles C, Hopkins RJ, Gamble GD, Greco EM, Gatsonis C, Aberle D. Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy. Am J Respir Crit Care Med 2016. [PMID: 26199983 DOI: 10.1164/rccm.201505-0894oc] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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 adenocarcinoma-related 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.
Collapse
Affiliation(s)
- Robert P Young
- 1 School of Biological Sciences and.,2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Fenghai Duan
- 3 Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Caroline Chiles
- 4 Department of Radiology, Comprehensive Cancer Center, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina; and
| | - Raewyn J Hopkins
- 2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Greg D Gamble
- 2 Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Erin M Greco
- 3 Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Constantine Gatsonis
- 3 Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Denise Aberle
- 5 Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
40
|
de-Torres JP, Marín JM, Casanova C, Pinto-Plata V, Divo M, Cote C, Celli BR, Zulueta JJ. Identification of COPD Patients at High Risk for Lung Cancer Mortality Using the COPD-LUCSS-DLCO. Chest 2016; 149:936-42. [DOI: 10.1378/chest.15-1868] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/18/2015] [Accepted: 09/29/2015] [Indexed: 12/18/2022] Open
|
41
|
Qiang G, Liang C, Xiao F, Yu Q, Wen H, Song Z, Tian Y, Shi B, Guo Y, Liu D. Impact of chronic obstructive pulmonary disease on postoperative recurrence in patients with resected non-small-cell lung cancer. Int J Chron Obstruct Pulmon Dis 2015; 11:43-9. [PMID: 26766906 PMCID: PMC4699520 DOI: 10.2147/copd.s97411] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose This study aimed to determine whether the severity of chronic obstructive pulmonary disease (COPD) affects recurrence-free survival in non-small-cell lung cancer (NSCLC) patients after surgical resection. Patients and methods A retrospective study was performed on 421 consecutive patients who had undergone lobectomy for NSCLC from January 2008 to June 2011. Classification of COPD severity was based on guidelines of the Global Initiative for Chronic Obstructive Lung Disease (GOLD). Characteristics among the three subgroups were compared and recurrence-free survivals were analyzed. Results A total of 172 patients were diagnosed with COPD (124 as GOLD-1, 46 as GOLD-2, and two as GOLD-3). The frequencies of recurrence were significantly higher in patients with higher COPD grades (P<0.001). Recurrence-free survival at 5 years was 78.1%, 70.4%, and 46.4% in non-COPD, mild COPD, and moderate/severe COPD groups, respectively (P<0.001). By univariate analysis, the age, sex, smoking history, COPD severity, tumor size, histology, and pathological stage were associated with recurrence-free survival. Multivariate analysis showed that older age, male, moderate/severe COPD, and advanced stage were independent risk factors associated with recurrence-free survival. Conclusion NSCLC patients with COPD are at high risk for postoperative recurrence, and moderate/severe COPD is an independent unfavorable prognostic factor.
Collapse
Affiliation(s)
- Guangliang Qiang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Chaoyang Liang
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Fei Xiao
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Qiduo Yu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Huanshun Wen
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Zhiyi Song
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yanchu Tian
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Bin Shi
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Yongqing Guo
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Deruo Liu
- Department of Thoracic Surgery, China-Japan Friendship Hospital, Beijing, People's Republic of China
| |
Collapse
|
42
|
Abstract
Chronic obstructive pulmonary disease (COPD), characterized by chronic airways inflammation and progressive airflow limitation, is a common, preventable and treatable disease. Worldwide, COPD is a major cause of morbidity and mortality; smoking tobacco is the most important risk factor. This translational review of recent updates in COPD care for the primary care audience, includes recommendations from the 2015 Global Initiative for chronic obstructive lung disease (GOLD) report on diagnosis, pharmacological and non-pharmacological treatment, prevalence of comorbidities, management of exacerbations and the asthma and COPD overlap syndrome, with a focus on the importance and benefit of physical activity and exercise in COPD patients. Exacerbations and comorbidities contribute to the overall severity of COPD in individual patients. Management of exacerbations includes reducing the impact of the current exacerbation and preventing development of subsequent episodes. Healthcare professionals need to be alert to comorbidities, such as cardiovascular disease, anxiety/depression, lung cancer, infections and diabetes, which are common in COPD patients and can have a significant impact on HRQoL and prognosis. Pulmonary rehabilitation is recommended by a number of guidelines for all symptomatic COPD patients, regardless of severity, and involves exercise training, patient education, nutritional advice and psychosocial support. At all stages of COPD, regular physical activity and exercise can aid symptom control, improve HRQoL, reduce rates of hospitalization, and improve morbidity and respiratory mortality. Healthcare professionals play a pivotal role in improving HRQoL and health-related outcomes in COPD patients to meet their specific needs and in providing appropriate diagnosis, management and advice on smoking cessation.
Collapse
Affiliation(s)
- Christine Garvey
- a Department of Sleep Disorders and Pulmonary Rehabilitation, University of California San Francisco , San Francisco , CA , USA
| |
Collapse
|
43
|
Gao YH, Guan WJ, Liu Q, Wang HQ, Zhu YN, Chen RC, Zhang GJ. Impact of COPD and emphysema on survival of patients with lung cancer: A meta-analysis of observational studies. Respirology 2015; 21:269-79. [PMID: 26567533 DOI: 10.1111/resp.12661] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/20/2015] [Accepted: 07/30/2015] [Indexed: 12/20/2022]
Abstract
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. Meta-analyses 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.
Collapse
Affiliation(s)
- Yong-Hua Gao
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei-Jie Guan
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Qi Liu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hua-Qi Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ya-Nan Zhu
- Department of Emergency Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Rong-Chang Chen
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guo-Jun Zhang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| |
Collapse
|
44
|
Fernández de Córdova-Aguirre J, Guzmán-Guillen K, Álvarez-Serrano M, Vintimilla-Maldonado J. Risk factors for chronic obstructive pulmonary disease: Results of the FARIECE study. REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2015. [DOI: 10.1016/j.hgmx.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
45
|
Jackutė J, Žemaitis M, Pranys D, Šitkauskienė B, Miliauskas S, Bajoriūnas V, Sakalauskas R. Distribution of CD4(+) and CD8(+) T cells in tumor islets and stroma from patients with non-small cell lung cancer in association with COPD and smoking. MEDICINA-LITHUANIA 2015; 51:263-71. [PMID: 26674143 DOI: 10.1016/j.medici.2015.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/31/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVE The immune system plays an important role in non-small cell lung cancer (NSCLC) and chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the infiltration patterns of CD4(+) and CD8(+) T cells in NSCLC and to analyze their relation to COPD, smoking status and other clinicopathologic variables. MATERIALS AND METHODS Lung tissue specimens from 50 patients who underwent surgery for NSCLC (stages I-III) and 10 control group subjects were analyzed immunohistochemically. RESULTS NSCLC patients had a greater number of CD4(+) and CD8(+) T cells infiltrating the lung tissue than the control group (P=0.001) with predominant infiltration in the tumor stroma. We found a significant association between the number of total and tumor stroma-infiltrating CD4(+) and CD8(+) T cells, and smoking status (P<0.05). There were more CD8(+) T cells in the tumor stroma and fewer in the tumor islets in NSCLC patients with COPD as compared to NSCLC patients without COPD (P<0.05). However, there was no such association between CD4(+) T cells and COPD status. A high level of CD8(+) T cell infiltration in the tumor stroma was independently associated with the coexistence of COPD in multivariate analysis (P<0.05). CONCLUSIONS According to our data, COPD but not smoking seems to be associated with higher infiltration of CD8(+) T cells in the tumor stroma of patients with NSCLC. It allows us to hypothesize that NSCLC patients with coexisting COPD may have a more favorable outcome due to anticancer properties of stromal CD8(+) T cells.
Collapse
Affiliation(s)
- Jurgita Jackutė
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Marius Žemaitis
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Darius Pranys
- Department of Pathology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Brigita Šitkauskienė
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Skaidrius Miliauskas
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Vytis Bajoriūnas
- Department of Cardiac, Thoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimundas Sakalauskas
- Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
46
|
Gottlieb M, Marsaa K, Godtfredsen NS, Mellemgaard A. Prevalence and management of pulmonary comorbidity in patients with lung and head and neck cancer. Acta Oncol 2015; 54:767-71. [PMID: 25907821 DOI: 10.3109/0284186x.2014.1001496] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The simultaneous presence of cancer and other medical conditions (comorbidity) is frequent. Cigarette smoking is the major risk factor for as well head and neck cancer (HNC) and lung cancer (LC) as chronic obstructive pulmonary disease (COPD). COPD is the most common comorbidity in LC patients, and presence of COPD worsens the prognosis of HNC and LC. COPD is under-diagnosed and under-treated in the Danish population. The aims of this study were to determine the prevalence of COPD in a HNC and LC population, and to determine the need and feasibility of a randomized controlled phase II trial comparing usual care with optimized medical treatment of COPD in cancer patients. MATERIAL AND METHODS All patients with HNC or LC referred for oncologic treatment in a university hospital during a 10-month period were invited to attend a pulmonary clinic for evaluation of lung function. Patients who were found to have concomitant COPD were randomized to intervention or usual care. Primary endpoints were prevalence of COPD among the referred patients with either LC or HNC, and further whether the patients that were diagnosed with COPD already received treatment in accordance with Danish COPD guidelines. Secondary outcome was feasibility, i.e. the proportion of eligible patients that accepted follow-up in the pulmonary clinic for 24 weeks in addition to oncological treatment. The design of the randomized trail is described in detail. RESULTS In total 130 patients of whom 65% had LC and 35% HNC have been screened during the first seven months of this ongoing trial. Sixty-eight percent of LC patients and 22% of HNC patients had COPD. All but one of 68 eligible patients accepted randomization. Nearly one third (31%) of the LC and HNC patients with COPD were diagnosed prior to study entry, and of these, only 33% were receiving correct treatment according to current guidelines. CONCLUSION For patients with LC, and to a lesser extend HNC, there is a need for improved diagnosis and treatment of concomitant COPD. Furthermore, patients found it acceptable to be scheduled for a 24-week follow-up in a pulmonary clinic along with their oncological treatment.
Collapse
Affiliation(s)
- Magnus Gottlieb
- Department of Respiratory Medicine, Hvidovre University Hospital , Hvidovre , Denmark
| | | | | | | |
Collapse
|