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Original Research: Lung Cancer |

The Impact of Coexisting COPD on Survival of Patients With Early-Stage Non-small Cell Lung Cancer Undergoing Surgical ResectionEffect of Coexisting COPD on Lung Cancer Survival

Rihong Zhai, MD, PhD; Xiaojin Yu, PhD; Andrea Shafer, MPH; John C. Wain, MD, FCCP; David C. Christiani, MD, FCCP
Author and Funding Information

From the Department of Environmental Health (Drs Zhai, Yu, and Christiani), Harvard School of Public Health; and the Department of Medicine (Dr Christiani and Ms Shafer), and the Department of Surgery (Dr Wain), Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Correspondence to: David C. Christiani, MD, FCCP, Harvard School of Public Health, 665 Huntington Ave, I-1401, Boston, MA 02115; e-mail: dchris@hsph.harvard.edu


Funding/Support: The work was supported by the National Institutes of Health [Grants CA092824, CA074386, CA090578, and ES00002].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2014;145(2):346-353. doi:10.1378/chest.13-1176
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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.

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