Impact of coexistent preserved ratio impaired spirometry on the survival of patients with lung cancer: Analysis of data from the Korean Association for Lung Cancer Registry

Heo, I Re; Kim, Ho Cheol; Lee, Seung Jun; Yoo, Jung‐Wan; Ju, Sunmi; Jeong, Yi Yeong; Lee, Jong Deog; Cho, Yu Ji; Jeong, Jong Hwan; Heo, Manbong; Jung, Seul; Kim, Tae Hoon

doi:10.1111/1759-7714.14095

Cited by 9 publications

(12 citation statements)

References 40 publications

(64 reference statements)

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“…Our study’s results indicating a significant impact are the first such finding in a US general population. Nevertheless, these findings align with research from South Korea which found PRISm increased the risk of mortality from lung cancer [ 59 ].…”

Section: Discussionsupporting

confidence: 88%

The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012

Cadham,

Oh,

Han

et al. 2024

Respir Res

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Background We estimated the prevalence and mortality risks of preserved ratio impaired spirometry (PRISm) and chronic obstructive pulmonary disease (COPD) in the US adult population. Methods We linked three waves of pre-bronchodilator spirometry data from the US National Health and Nutritional Examination Survey (2007–2012) with the National Death Index. The analytic sample included adults ages 20 to 79 without missing data on age, sex, height, BMI, race/ethnicity, and smoking status. We defined COPD (GOLD 1, 2, and 3–4) and PRISm using FEV1/FVC cut points by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). We compared the prevalence of GOLD stages and PRISm by covariates across the three waves. We estimated adjusted all-cause and cause-specific mortality risks by COPD stage and PRISm using all three waves combined. Results Prevalence of COPD and PRISm from 2007–2012 ranged from 13.1%-14.3% and 9.6%-10.2%, respectively. We found significant differences in prevalence by sex, age, smoking status, and race/ethnicity. Males had higher rates of COPD regardless of stage, while females had higher rates of PRISm. COPD prevalence increased with age, but not PRISm, which was highest among middle-aged individuals. Compared to current and never smokers, former smokers showed lower rates of PRISm but higher rates of GOLD 1. COPD prevalence was highest among non-Hispanic White individuals, and PRISm was notably higher among non-Hispanic Black individuals (range 31.4%-37.4%). We found associations between PRISm and all-cause mortality (hazard ratio [HR]: 2.3 95% CI: 1.9—2.9) and various cause-specific deaths (HR ranges: 2.0–5.3). We also found associations between GOLD 2 (HR: 2.1, 95% CI: 1.7–2.6) or higher (HR: 4.2, 95% CI: 2.7–6.5) and all-cause mortality. Cause-specific mortality risk varied within COPD stages but typically increased with higher GOLD stage. Conclusions The prevalence of COPD and PRISm remained stable from 2007–2012. Greater attention should be paid to the potential impacts of PRISm due to its higher prevalence in minority groups and its associations with mortality across various causes including cancer.

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Section: Discussionsupporting

confidence: 88%

The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012

Cadham,

Oh,

Han

et al. 2024

Respir Res

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“…[33] Non-small cell and small cell lung cancer patients with PRISm had poorer overall survival with a 62% higher risk of mortality, compared to those with AO or normal lung function. [23] In our cohort study, individuals with AO had a 30% higher risk of lung cancer mortality which was relatively low compared to other studies. For instance, in studies conducted on lung cancer patients, AO was associated with poorer overall and progression-free survivals with more than two times higher mortality risks.…”

Section: Discussionmentioning

confidence: 57%

“…Higher proportions of PRISm could be found in hospital-based or cohorts of high-risk groups. It was as high as 21.3% in the Korean lung cancer registry[23], 16.7% in a Japanese study of individuals over 40 years of age[24], and 17-24% in a hospital study from the University of Iowa[11]. Restrictive patterns of lung function impairment can be observed in interstitial lung diseases such as idiopathic pulmonary fibrosis (IPF).…”

Section: Discussionmentioning

confidence: 99%

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

Kyaw,

Tsai,

Wen

et al. 2023

Preprint

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BackgroundIt has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as preserved ratio impaired spirometry (PRISm) and airflow obstruction (AO), on the incidence and mortality of lung cancer in both general and never-smoker populations remains unclear. We wished to examine the effect of lung function impairments on lung cancer risks.MethodsThis was a retrospective cohort study of individuals from a health surveillance program in Taiwan who underwent baseline spirometry tests at the entry point. PRISm was defined as an FEV1/FVC (Forced Expiratory Volume in 1 second/ Forced Vital Capacity) ratio >0.7 and FEV1 <0.8, while AO was defined as an FEV1/FVC ratio <0.7. Cox proportional hazards models and cubic spline curves were used to examine the associations between lung function impairments and lung cancer risks.ResultsThe study included 461,183 individuals, of whom 14.3% had PRISm and 7.9% had AO. A total of 4,038 cases of lung cancer and 3,314 lung cancer-related deaths were identified during the 23 years of follow-up. Individuals with PRISm and AO exhibited a higher risk of lung cancer incidence and mortality compared to those with normal lung function. The adjusted hazard ratios (aHRs) and 95% confidence intervals (95%CI) were 1.14 (1.03-1.26) and 1.23 (1.10-1.37) in the overall cohort, and 1.08 (0.93-1.24), and 1.23 (1.05-1.45) in the never-smoker cohort. The risks of both developing and dying of lung cancer increased with the severity levels of lung function impairments and lower FEV1 values.ConclusionImpaired lung function is associated with increased risks of developing lung cancer and subsequent mortality. The study highlights the importance of considering lung function in lung cancer screening for better candidate selection.WHAT IS ALREADY KNOWN ON THIS TOPICImpaired lung function is a common condition that can be observed in people with smoking habits and other respiratory illnesses including lung cancer. However, the effect of lung function impairment alone on the risks of lung cancer incidence and mortality is not clear. Early detection of lung cancer is essential for effective disease management, and lung cancer screening is a key preventive measure that can help achieve this. However, current lung cancer screening guidelines only consider age and smoking history, not lung function status.WHY THIS STUDY ADDSImpaired lung function is associated with an increased risk of lung cancer in a large Asian cohort. Nonetheless, among never-smoking individuals exhibiting spirometrically defined PRISM/AO, the observed risks were found to lack statistical significance, with the exception of lung cancer mortality within the non-smoking PRISm subgroup.HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICYLung function status should be taken into consideration in lung cancer screening criteria. The importance of monitoring and addressing lung function impairment in lung cancer risk management should also be widely shared with the medical community and the public.

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“…A total of 1,172 patients with poor lung function undergoing VATS were initially selected. According to the prior research (18,22,(26)(27)(28)(29)(30) and following the recent GOLD guidelines (31), we define poor lung function as post-bronchodilator FEV1/FVC < 70%.…”

Section: Patients Inclusionmentioning

confidence: 99%

Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Non-small-cell Lung Cancer Patients With Poor Lung Function: Short- and Long-Term Outcomes

Wang

Jiang

et al. 2022

Front. Surg.

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ObjectiveThe goal of this study was to explore the feasibility and safety of spontaneous ventilation video-assisted thoracoscopic surgery (SV-VATS) for non-small-cell lung cancer (NSCLC) patients with poor lung function.MethodsNSCLC patients with poor lung function who underwent SV-VATS or mechanical ventilation VATS (MV-VATS) from 2011 to 2018 were analyzed. 1:2 Propensity score matching (PSM) was applied, and the short- and long-term outcomes between the SV-VATS group and the MV-VATS group were compared.ResultsAnesthesia time (226.18 ± 64.89 min vs. 248.27 ± 76.07 min; P = 0.03), operative time (140.85 ± 76.07 min vs. 163.12 ± 69.37 min; P = 0.01), days of postoperative hospitalization (7.29 ± 3.35 days vs. 8.40 ± 7.89 days; P = 0.04), and days of chest tube use (4.15 ± 2.89 days vs. 5.15 ± 3.54 days; P = 0.01), the number of N1 station lymph node dissection (2.94 ± 3.24 vs. 4.34 ± 4.15; P = 0.005) and systemic immune-inflammation index (3855.43 ± 3618.61 vs. 2908.11 ± 2933.89; P = 0.04) were lower in SV-VATS group. Overall survival and disease-free survival were not significantly different between the two groups (OS: HR 0.66, 95% CI: 0.41–1.07, P = 0.09; DFS: HR 0.78, 95% CI: 0.42–1.45, P = 0.43).ConclusionsComparable short-term and long-term outcomes indicated that SV-VATS is a feasible and safe method and might be an alternative to MV-VATS when managing NSCLC patients with poor lung function.

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Impact of coexistent preserved ratio impaired spirometry on the survival of patients with lung cancer: Analysis of data from the Korean Association for Lung Cancer Registry

Cited by 9 publications

References 40 publications

The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012

The prevalence and mortality risks of PRISm and COPD in the United States from NHANES 2007–2012

Impaired lung function and lung cancer risk in 461,183 healthy individuals: a cohort study

Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Non-small-cell Lung Cancer Patients With Poor Lung Function: Short- and Long-Term Outcomes

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