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Abstract
BackgroundRecent studies suggest that coexistence of chronic obstructive pulmonary disease (COPD) might be independently related to a worse prognosis for lung cancer. However, because data on the substantial prevalence of COPD and its severity in Asian lung cancer patients remain limited, clinical impact of prevalence and severity of COPD among the population has not been fully evaluated. Furthermore, patients with COPD often have comorbidities. Thus, whether the decision-making process for therapeutic management of lung cancer patients might be independently affected by COPD remains elusive.MethodsClinical impact of prevalence and severity of COPD were evaluated in 270 Japanese patients with newly diagnosed lung cancer who were sequentially registered and underwent bronchoscopy from August 2010 to July 2012 at Nagoya University hospital. Furthermore, to explore whether or not the severity of airflow obstruction might affect the decision to propose thoracic surgery with curative intent, we evaluated data from patients with lung cancer at stage 1A to 3A who underwent spirometry and bronchoscopy.ResultsThe prevalence rate of COPD was 54.4% among Japanese patients with lung cancer who underwent bronchoscopy. The incidence of Global Initiative for Chronic Obstructive Lung Disease (GOLD) grades 1 and 2 was significantly higher than that of GOLD grade 3. Although COPD-related comorbidities were not independent factors for proposing thoracic surgery, the number of thoracic surgeries performed was significantly less in the COPD group than the non-COPD group. Multivariate analysis showed that more severe airway obstruction, advanced clinical staging, and higher age, were independent factors associated with the decision on thoracic surgery.ConclusionsWe demonstrated a high prevalence of COPD among Japanese lung cancer patients. Based on the knowledge that severity of COPD is one of the most important factors in the therapeutic decision, comprehensive assessment of COPD at bronchoscopy might allow us to implement the optimum management for lung cancer patients.
Highlights
Recent studies suggest that coexistence of chronic obstructive pulmonary disease (COPD) might be independently related to a worse prognosis for lung cancer
Many studies suggest that the increasing incidence of adenocarcinoma in Asian populations including the Japanese population might be associated with epidermal growth factor receptor (EGFR) mutation rather than with smoking [11,12]
Et al show a low prevalence of COPD in hospitalized lung cancer patients in China (21.6%; 705/3263 cases) [13], whereas we recently demonstrated that the prevalence of COPD was more than 40% in Japanese patients undergoing thoracic surgery [14]
Summary
Recent studies suggest that coexistence of chronic obstructive pulmonary disease (COPD) might be independently related to a worse prognosis for lung cancer. Whether the decision-making process for therapeutic management of lung cancer patients might be independently affected by COPD remains elusive. Because older patients with COPD are often known to have much lower pulmonary function as well as other comorbidities [7,8], whether or not the decision-making process for therapeutic management of lung cancer patients might be independently affected by the coexistence and severity of COPD remains elusive. We evaluated whether or not the prevalence and severity of COPD might independently affect the decisionmaking process for the treatment of lung cancer in this population
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