Impact of Chronic Obstruction Pulmonary Disease on Survival in Patients with Advanced Stage Lung Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy

Abstract

Background: To date, no data are available regarding the effect of chronic obstruction pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on survival in patients with lung squamous cell carcinoma (SCC) receiving definitive concurrent chemoradiotherapy (CCRT). Patients and methods: We enrolled 3986 patients with clinical stage IIIA–IIIB, unresectable lung SCC, who had received standard definitive CCRT, and categorized them into two groups based on their COPD status to compare overall survival outcomes. We also examined the effects of COPD severity (0, 1, or ≥2 hospitalizations for COPDA within 1 year before CCRT). Results: In the inverse probability of treatment weighting (IPTW)-adjusted model, the adjusted hazard ratio (aHR) (95% confidence interval (CI)) of all-cause death for COPD was 1.04 (1.01, 1.16), compared no COPD in patients with stage IIIA–IIIB lung SCC receiving definitive CCRT. In the IPTW-adjusted model, the aHRs (95% CIs) of 1 and ≥ 2 hospitalizations for COPDAE within 1 year before CCRT were 1.32 (1.19, 1.46) and 1.81 (1.49, 2.19) respectively, compared with no hospitalization for COPDAE. Conclusion: COPD and its severity are significant independent risk factors for all-cause death in patients with stage IIIA–IIIB lung SCC receiving definitive CCRT. Hospitalization for COPDAE within 1 year before CCRT is the significant independent risk factor for lung cancer death in the patients with stage IIIA–IIIB lung SCC receiving definitive CCRT.

Survival Impact of Current-Smoking-Related COPD or COPD with Acute Exacerbation on Bladder Preservation through Concurrent Chemoradiotherapy for Muscle-Invasive Bladder Urothelial Carcinoma

“…The potential mechanism of smoking-induced resistance to cisplatin is changes in the expression of drug influx and efflux transporters, decreased uptake, inactivation by nucleophilic compounds, or accelerated DNA repair in smoking-exposed urothelial cells [37,41,42]. Moreover, COPD has been associated with poor survival in lung and extrapulmonary cancer treatments [43][44][45][46]. Patients with cancer having COPD have worse survival than those without COPD [43][44][45][46][47] because COPD increases C-reactive protein levels, a biomarker of systemic inflammation, which is associated with an increased risk of cancer mortality, including for extrapulmonary cancers [47].…”

“…Moreover, COPD has been associated with poor survival in lung and extrapulmonary cancer treatments [43][44][45][46]. Patients with cancer having COPD have worse survival than those without COPD [43][44][45][46][47] because COPD increases C-reactive protein levels, a biomarker of systemic inflammation, which is associated with an increased risk of cancer mortality, including for extrapulmonary cancers [47]. Similarly, in the largest meta-analysis of its kind, Danesh and colleagues indicated that plasma fibrinogen, another nonspecific marker of systemic inflammation, is associated with both pulmonary and extrapulmonary cancers in smokers and never smokers [48].…”

“…For example, patients with head and neck cancer or lung cancer who continue to smoke during radiotherapy have lower response rates and survival rates than patients who do not smoke during radiotherapy [61,62]. Clinical studies have demonstrated that patients with lung cancer with severe or very severe COPD had a lower OS than did those without COPD or those with mild or moderate COPD [43,45]. However, these studies scarcely focus on the survival impact of COPD on patients with nonlung cancers.…”

“…Taken together, these findings imply that both smoking and COPD result in poor OS and worse CSS in patients with cancers receiving cisplatin-based chemotherapy and radiotherapy as curative-intent treatments. CCRT for bladder preservation using cisplatin-based regimen might be influenced by current-smoking-related COPD [37,[41][42][43][44][45][46][47]. Hospitalization for COPDAE within 1 year before CCRT is associated with COPD severity and is proportional to the smoking level.…”

Current-Smoking-Related COPD or COPD With Acute Exacerbation is Associated With Poorer Survival Following Oral Cavity Squamous Cell Carcinoma Surgery

“…29,30 Thus, pre-existing COPD and current smoking status are highly prevalent in patients with OCSCC. 25,31 Smoking [32][33][34][35][36][37][38][39] and overwhelming comorbidity such as COPD [20][21][22][23][24] are independently associated with poorer survival in patients with cancer as well as greater resistance to cancer treatments such as radiotherapy or CCRT. Surgical complications or perioperative risk of morbidity and mortality also increase in patients with cancer because of current smoking status or COPD.…”