P1.12-13 Impact of Chronic Obstructive Pulmonary Disease on the Survival of Patients with Extensive-Disease Small Cell Lung Cancer

Abstract

Small cell lung cancer (SCLC) is a highly fatal lung malignancy. Cigarette smoking is an important cause of SCLC, and most patients have heavy smoking history. Also, smoking is an established risk factor of chronic obstructive pulmonary disease (COPD). Therefore, patients who are diagnosed with SCLC have high chance to coincide with COPD. However, the coincidence rate of COPD and SCLC are not known well. Moreover, the impact of COPD on the mortality of patients with SCLC, especially for patients with extensive disease (ED) is not reported yet. Therefore, we conducted investigation of clinical features and survival differences between patients who were diagnosed with SCLC with COPD or patients without COPD. We retrospectively reviewed medical records of patients who were diagnosed with SCLC-ED and received treatment between 2002 and 2016 at the Korea University Hospital. Among the 182 patients who were diagnosed with SCLC-ED and received palliative chemotherapy, 125 patients who had pulmonary function test report and previous or current smoking history were included. According to the global initiative for chronic obstructive lung disease (GOLD) classification, COPD was defined as FEV1/FVC <0.70. Among 125 patients, COPD was present in 69 (55.2 %) patients. Among the patients with COPD, 48 (69.5%) patients did not know the COPD before the diagnosis of SCLC. Patients in the COPD group were older (mean age ± standard deviation, 68.9 ± 8.2 versus 65.6± 8.4 years; p=0.03). The mean FEV1(L) and predicted percent of FEV1 were 1.7L (67.9%) in COPD group and 2.9L (81.2%) in non-COPD group. Gender, body mass index, amount of smoking, ECOG performance status and neutrophil to lymphocyte ratio were not different between the two groups. Median overall survival of all patients was 8.6 months (95% confidential index [CI], 7.7-9.5). Median overall survival of the first-line chemotherapy between patients with COPD and patients without COPD was not statistically different (p=0.382). Median progression-free survival of the first-line chemotherapy between the two groups also were not different (p=0.372). In the analysis of COPD group, FEV1(L) and predicted percent of FEV1 did not affect survival among the patients with COPD (p=0.289). In conclusion, the presence of COPD at the diagnosis of SCLC-ED does not affect survival outcome in patients who were treated palliative chemotherapy. Even though the patients have severe obstructive pulmonary disease, active chemotherapy has to be considered with priority for the patients with SCLC-ED.