title: Impact of COPD in patients with lung cancer and advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors.
abstract: While it is relatively well known that the prognosis of patients with lung cancer (LC) treated with surgery is worse in the presence of chronic obstructive pulmonary disease (COPD), it is unknown if this assessment can be extrapolated to patients with advanced disease treated with chemotherapy and/or tyrosine kinase inhibitors. The aim of our study is to analyze the clinical characteristics and survival rates in patients with LC and COPD, and to compare these to the patients without airflow obstruction. From 471 evaluable patients, 324 (69%) were not treated with surgery due to disseminated disease (stages 3B and 4). Of them, 47.7% also had COPD. All patients were treated at the moment of diagnosis according to National Comprehensive Cancer Network guidelines with platinum-based chemotherapy or tyrosine kinase inhibitors. Kaplan-Meier curves showed no significant differences in overall survival between COPD and non-COPD patients (log-rank P=0.65). In the multivariate Cox proportional hazard model adjusting for the most relevant variables, the adjusted hazard ratio (HRadj) was statistically significant for performance status (HRadj =1.33, 95% confidence interval [CI]: 1.11-1.59; P=0.002) and clinical stage (HRadj =0.67, 95% CI: 0.50-0.89; P=0.006), but not for COPD status (HRadj =1.20, 95% CI: 0.83-1.50; P=0.46). Our conclusion is that at present, when using standard care in advanced LC (stages 3B and 4), COPD does not have a significant deleterious impact on overall survival.
authors.affiliation: Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Izquierdo
authors.affiliation: Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Resano
authors.affiliation: Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain.
authors.forename: Abdulkader
authors.initials: A
authors.lastname: El Hachem
authors.affiliation: Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain.
authors.forename: Desiré
authors.initials: D
authors.lastname: Graziani
authors.affiliation: Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Almonacid
authors.affiliation: Pulmonology Department, Guadalajara University Hospital, Guadalajara, Spain.
authors.forename: Ignacio M
authors.initials: IM
authors.lastname: Sánchez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000201:enzymology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011505:Protein-Tyrosine Kinases / Q000037:antagonists & inhibitors* / Q000378:metabolism; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011505:Protein-Tyrosine Kinases
keywords: chemotherapy; chronic obstructive pulmonary disease; extended disease; lung cancer; survival