Lung cancer reoccurrence and mortality is accelerated with episodic hypoxemia

Several studies have shown an association between intermittent hypoxia (IH), nocturnal hypoxemia (NH), and obstructive sleep apnea (OSA) with an increased risk for malignancies. We studied whether IH or NH are associated with early recurrence or mortality following curative lung cancer therapy.

Retrospective cohort study of adults with stage 1 and 2 non-small cell lung cancer who received overnight oximetry (OXY) prior to undergoing successful surgical resection. Patients were classified as increased IH (4 % oxygen desaturation index (ODI) ≥15) or low IH (ODI<15). Outcomes of interest were cause-specific cancer recurrence alone and a composite cancer recurrence or death. We calculated the rates of events using Kaplan-Meier and cumulative incidence estimates. Cox models evaluated the association between exposure and composite outcome.

Among 559 patients (52 % female) meeting inclusion criteria, 107 (19 %) experienced recurrence and 17 (3 %) died over a median follow-up of 2 years. ODI≥15 was strongly associated with increased risk of recurrence or death (adjusted HR = 6.71, 95 % CI: 4.61-9.78, p < 0.001) compared to ODI <15. Other hypoxemia measures, including minutes SpO2<89 % and time in desaturation events, were also associated with higher hazards, while higher nadir SpO₂ was associated with lower risk of events.

IH and NH are strong risk factors for early lung cancer recurrence and mortality. The observed strong association suggests that IH and NH markers, likely related to OSA, could serve as independent predictors, emphasizing the need for further causation studies to validate these findings and explore preventive treatments.