Lung cancer in patients with COPD and factors associated with reduced survival

Background. A combination of different types of lung cancer and chronic obstructive pulmonary disease (COPD) is very common. COPD, accompanied by ventilation disorders and, often, respiratory failure, is a significant additional risk factor for mortality in these patients. Identification of risk factors for mortality in patients with lung cancer and COPD can potentially be associated with better long-term outcomes.

Materials and methods. Using a Cox regression model based on information about the outcome of the disease and life expectancy after treatment initiation, a survival analysis was performed with an assessment of the contribution of various clinical and anamnestic factors for a group of 118 COPD patients with primary diagnosed lung cancer. These patients received treatment at the Cancer Research Institute in Tomsk in 2013–2019.

Results. The study included 118 patients (87.3% men and 12.7% women). Among them, 77.97% of patients were active or former smokers with smoking index (SI) ≥ 10 pack-years, and 22% of patients had never smoked or had SI < 10 pack-years but had other risk factors for COPD. Peripheral lung cancer was detected in 45.8% of cases. Squamous cell carcinoma was noted in 54.2% of cases, adenocarcinoma – in 34.7%, large cell carcinoma – in 1.7%, small cell carcinoma – in 5.9%, and carcinoid tumors – in 2.5% of cases. Patients were characterized by varying degrees of severity of ventilation disorders in accordance with the GOLD classification: stage 1 was observed in 44% of patients, stage 2 – in 38.1 % of patients, stage 3 – in 16.9 % of patients, and stage 4 – in one patient. Threeyear mortality was 28.12%.

Conclusion. According to the results of the Cox regression analysis, factors that significantly reduced the survival rate of patients with lung cancer in combination with COPD were more severe stages in terms of the size of  the primary tumor and its localization, the prevalence of metastasis (according to TNM classification), more severe dyspnea (mMRC scale), lower oxygen saturation values, atelectasis, and episodes of pneumonia, including paracancrotic pneumonia, over the previous 12 months. The presence of certain types of metastases, such as metastatic lesions of the pleura, adrenal glands, distant non-regional lymph nodes, and bones should also be noted as negative factors for survival. It is worth noting that surgical treatment of the primary tumor was associated with an increase in the survival rate in patients with lung cancer in combination with COPD.

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