title: The impact of coexisting COPD on survival of patients with early-stage non-small cell lung cancer undergoing surgical resection.
abstract: BACKGROUND
  COPD is a recognized risk factor for lung cancer, but studies of coexisting COPD in relation to lung cancer outcomes are limited. We assessed the impact of COPD on overall survival (OS) and progression-free survival (PFS) in patients with early-stage non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Patients (N = 902) with early-stage (stage IA-IIB) NSCLC treated with surgical resection were retrospectively analyzed. The association of self-reported, physician-diagnosed COPD with survivals of NSCLC was assessed using the log-rank and Cox regression models, adjusting for age, sex, BMI, smoking, stages, and performance status.
  
  
  RESULTS
  Among this cohort of patients with NSCLC, 330 cases had physician-diagnosed COPD, and 572 did not have COPD. The 5-year OS in patients with COPD (54.4%) was significantly lower (P = .0002) than that in patients without COPD (69.0%). The 5-year PFS rates for patients with COPD and without COPD were 50.1% and 60.6%, respectively (P = .007). Compared with patients without COPD, patients with COPD had increased risk of worse OS (adjusted hazard ratio [HRadj] = 1.41, P = .002) and PFS (HRadj = 1.67, P = .003). The associations between COPD and worse survival outcomes were stronger in men and in squamous cell carcinoma (SCC).
  
  
  CONCLUSIONS
  Coexisting COPD is associated with worse survival outcomes in patients with early-stage NSCLC, particularly for men and for SCC.
authors.affiliation: Department of Environmental Health, Harvard School of Public Health.
authors.forename: Rihong
authors.initials: R
authors.lastname: Zhai
authors.affiliation: Department of Environmental Health, Harvard School of Public Health.
authors.forename: Xiaojin
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Shafer
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.affiliation: Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: dchris@hsph.harvard.edu.
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008168:Lung / Q000473:pathology / Q000601:surgery; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome