Survival After Surgical Resection for Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

Abstract

The best curable therapy for lung cancer is surgical resection. Chronic obstructive pulmonary disease (COPD) may influence survival, and lung function is crucial in the preoperative assessment. We hypothesized that COPD would influence survival after lung cancer resection. During the period 2003 to 2013, 688 patients were operated on for stage I and II non-small cell lung cancer and prospectively registered. Spirometry was performed, and COPD categorized according to the definition by the Global Initiative for Chronic Obstructive Lung Disease. An explanatory strategy was used to investigate the relationship between severe COPD and survival. COPD was present in 455 patients (66.1%) and was severe in 51 (7.4%) and mild to moderate in 404 (58.7%), whereas 233 patients (33.9%) had normal lung function. Cumulative survival was similar in patients with normal lung function and patients with mild to moderate COPD. Patients with severe COPD had significantly reduced cumulative survival after 2 and 5 years of 63.5% (95% confidence interval [CI], 48.4% to 75.2%) and 41.8% (95% CI, 26.5% to 56.3%), respectively, compared with nonsevere COPD at 81.7% (95% CI, 77.4% to 85.2%) and 61.3% (95% CI, 55.3% to 66.6%), respectively. Severe COPD was associated with a 69% increased risk of mortality (adjusted hazard ratio, 1.69; 95% CI, 1.12 to 2.55). With careful preoperative selection, surgical resection may safely be offered to lung cancer patients with severe COPD. However, these patients have decreased long-term overall survival. Similar survival between patients with normal lung function and mild to moderate COPD suggests that similar indications for lung cancer operations may be applied.