Invited commentary

Abstract

This article by Sekine and associates [1Sekine Y. Yamada Y. Chiyo M. et al.Association of chronic obstructive pulmonary disease and tumor recurrence in patients with stage IA lung cancer after complete resection.Ann Thorac Surg. 2007; 84: 946-951Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar] seeks to address an important but often overlooked area of assessment of thoracic surgical results. Indeed, it contributes to our understanding of the close relation between chronic obstructive pulmonary disease (COPD) and lung cancer, as with other retrospective studies published in the past. In the present article the authors add to their previous contributions by addressing the interesting and seldom debated question of the relation between COPD male patients and survival in the framework of stage IA lung cancer. In a cohort of 251 patients, the results showed similar frequencies for all pulmonary complications except pneumonia between the non-COPD (n = 178) and COPD (n = 73) groups. Overall survival and disease-free survival were significantly worse in the COPD group than in the non-COPD group (p < 0.05). Prognostic factors were tumor size and severity of COPD. Overall the authors found that although the incidences of postoperative complications were acceptable in patients with COPD, these patients had poorer long-term survival due to a higher incidence of tumor recurrence. Why should thoracic surgeons be concerned with COPD or interested in this rigorous retrospective study? Is it because the risk of lung cancer recurrence in patients with COPD has been seldom studied up to now? No, rather because this study clarifies the long-term effect of volume loss by surgical resection (degree of functional loss and severity of the preoperative condition [ie, forced expiratory volume in 1 second]) in male patients with stage IA lung cancer and COPD. Surgery provides the best chance of prolonged survival for the early stage nonsmall cell lung cancer. It has also been shown that COPD is a strong promoting factor in lung cancer, although the mechanism has yet to be clarified. Therefore the hypothesis presented by the authors in the current article is entirely justified. Indeed this “simple” retrospective study carries and emphasizes the important, if sobering, intuitive message that there is a strong association between COPD and tumor recurrence in patients with stage IA lung cancer after complete resection. Obviously further research is needed to confirm the results of this single center investigation. Moreover some recent data suggest that gender may interfere in the results [2Lopez-Encuentra A. Astudillo J. Cerezal J. et al.Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S) Prognostic value of chronic obstructive pulmonary disease in 2994 cases of lung cancer.Eur J Cardiothorac Surg. 2005; 27: 8-13Crossref PubMed Scopus (61) Google Scholar]; the studied pathology is less common in women who therefore constitute a confounding variable. It would be useful to create a randomized study focusing on the difference in behavior and survival in women. Be that as it may, Sekine and associates [1Sekine Y. Yamada Y. Chiyo M. et al.Association of chronic obstructive pulmonary disease and tumor recurrence in patients with stage IA lung cancer after complete resection.Ann Thorac Surg. 2007; 84: 946-951Abstract Full Text Full Text PDF PubMed Scopus (68) Google Scholar] are to be congratulated on persevering in their investigations in this area. From the standpoint of medical care, thoracic surgeons would benefit from examining their results.