The burden of emphysema on lung cancer prognosis

Abstract

Chronic obstructive pulmonary disease (COPD) is a risk factor of lung cancer, even after correcting for smoking. Fibrocytes, which express features of macrophages and fibroblasts (CD45+fsp1+) could be a good candidate to link both diseases. Accumulating evidences suggest that fibrocytes promote lung cancer progression and fibrocytes’ increase is associated with reduced lung function in COPD. During follow-up after surgical resection for localized lung cancer, we tried to determine how COPD could impact prognosis and if bronchial fibrocytes increase was associated with specific outcomes. Methods: We conducted a retrospective study among 35 patients who underwent surgical resection for lung cancer. We collected patients’ characteristics : lung function: forced expiratory volume in one second (FEV1), total lung capacity (TLC), monoxide lung diffusion capacity (DLCO), PDL1 status (TPS score) and emphysema quantification on CT scan. Fibrocytes was quantified by immunohistochemistry in lung biopsies by a co-staining of fsp1+ and CD45+. Judgment criterion was progression-free-survival (PFS). Results: Patients were characterized as follows: male: 40%, mean age: 60.1 years, current smokers: 28%, mean FEV1: 87% predicted, mean TLC 103.5%, median density of fibrocytes: 62/mm3, expressing PD-L1(TPS score ³ 1%): 60%. Median PFS was 1903 days and significantly decreased among patients with airflow obstruction, hyperinflation, altered lung diffusion, expressing PDL1 status. Patients with fibrocytes’ density lower than median tend to have a worsen PFS (1756 days vs 1962 days p=0.06). Conclusion: After surgical resection for lung cancer, prognosis is negatively influenced by COPD and a low level of fibrocytes. Fibrocytes could link COPD and lung cancer.