Abstract
Simple SummaryThis is the first study to reveal that hospitalization frequency for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) before colon adenocarcinoma treatment is a severity-dependent and independent prognostic factor for overall survival in patients with stage I–III colon cancer receiving surgical resection and standard treatments. In patients with colon adenocarcinoma undergoing curative resection, those with chronic obstructive pulmonary disease (COPD) had poorer survival outcomes than had those without COPD. Hospitalization for AECOPD at least once within 1 year before colon adenocarcinoma diagnosis is an independent risk factor for poor overall survival in these patients, and a higher number of hospitalizations for AECOPD within 1 year before diagnosis was associated with poorer survival. Our study may be applied to accentuate the importance of COPD management, particularly the identification of frequent exacerbators and the prevention of AECOPD, before standard colon adenocarcinoma treatments are initiated.Purpose: To investigate whether chronic obstructive pulmonary disease (COPD) and COPD severity (acute exacerbation of COPD (AECOPD)) affect the survival outcomes of patients with colon adenocarcinoma receiving standard treatments. Methods: From the Taiwan Cancer Registry Database, we recruited patients with clinical stage I–III colon adenocarcinoma who had received surgery. The Cox proportional hazards model was used to analyze all-cause mortality. We categorized the patients into COPD and non-COPD (Group 1 and 2) groups through propensity score matching. Results: In total, 1512 patients were eligible for further comparative analysis between non-COPD (1008 patients) and COPD (504 patients) cohorts. In the multivariate Cox regression analysis, the adjusted hazard ratio (aHR; 95% confidence interval (CI)) for all-cause mortality for Group 1 compared with Group 2 was 1.17 (1.03, 1.29). In patients with colon adenocarcinoma undergoing curative resection, the aHRs (95% CIs) for all-cause mortality in patients with hospitalization frequencies of ≥1 and ≥2 times for AECOPD within 1 year before adenocarcinoma diagnosis were 1.08 (1.03, 1.51) and 1.55 (1.15, 2.09), respectively, compared with those without AECOPD. Conclusion: In patients with colon adenocarcinoma undergoing curative resection, COPD was associated with worse survival outcomes. Being hospitalized at least once for AECOPD within 1 year before colon adenocarcinoma diagnosis was an independent risk factor for poor overall survival in these patients, and a higher number of hospitalizations for AECOPD within 1 year before diagnosis was associated with poorer survival. Our study highlights the importance of COPD management, particularly the identification of frequent exacerbators and the prevention of AECOPD before standard colon adenocarcinoma treatments are applied.
Highlights
Chronic obstructive pulmonary disease (COPD) was the third leading cause of death and seventh leading cause of disability-adjusted life years worldwide in 2019 [1,2]
No head-to-head propensity-score matching (PSM) study had been conducted to estimate the overall survival (OS) of patients with colon cancer with different chronic obstructive pulmonary disease (COPD) histories and severity after they received surgical resection and standard treatments according to the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology (NCCN Guidelines [23])
We showed that hospitalization for acute exacerbation of COPD (AECOPD) within 1 year before surgical resection was an independent prognostic factor for survival in patients receiving standard treatments for stage I–III colon adenocarcinoma; patients with more frequent hospitalizations for AECOPD (≥2 within 1 year before surgical resection) before colon adenocarcinoma treatments had poorer survival outcomes than did those with less frequent AECOPD hospitalizations before colon adenocarcinoma treatments
Summary
Chronic obstructive pulmonary disease (COPD) was the third leading cause of death and seventh leading cause of disability-adjusted life years worldwide in 2019 [1,2]. COPD is a well-known independent risk factor for lung cancer [3,4,5]. The treatment outcome of colon cancer may be negatively affected by COPD because it increases the risk of postoperative complications, precludes patients from receiving adjuvant chemotherapy, and reduces the effectiveness of chemotherapy [8,9,10,11]. To our knowledge, for patients with colon cancer who received surgical resection and standard treatments, no study has been conducted to estimate the long-term mortality risk posed by their pre-existing COPD and their COPD severity (defined as the frequency of acute exacerbation of COPD (AECOPD) associated with hospitalization within 1 year before surgical resection in this study)
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