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Brief Report: Emphysema as a Prognostic Factor in Patients With Advanced NSCLC With COPD Receiving Immune Checkpoint
Madeleine Di Frisco1, Miguel F Sanmamed2, José María Ferrandez3
1Pulmonary Department, Clinica Universidad de Navarra, Pamplona, Spain; Department of Oncology, Clinica Universidad de Navarra, Pamplona, Spain.
Summary
Emphysema presence in patients with chronic obstructive pulmonary disease (COPD) and advanced non-small cell lung cancer (aNSCLC) receiving immunotherapy is linked to significantly longer overall survival. This finding suggests emphysema may serve as a prognostic marker in this patient group.
Area of Science:
- Pulmonology
- Oncology
- Radiology
Background:
- Chronic obstructive pulmonary disease (COPD) and emphysema are known lung cancer risk factors.
- Both conditions are independently associated with improved survival in advanced non-small cell lung cancer (aNSCLC) patients treated with immune checkpoint inhibitors (ICIs).
- The combined prognostic impact of COPD and emphysema in aNSCLC patients receiving immunotherapy remains unclear.
Purpose of the Study:
- To evaluate the prognostic role of emphysema in patients with COPD and advanced non-small cell lung cancer (aNSCLC) undergoing immunotherapy.
- To determine if emphysema presence influences overall survival (OS) and progression-free survival (PFS) in this specific patient cohort.
Main Methods:
- Retrospective analysis of 111 patients with aNSCLC and COPD (defined by spirometry) treated with single-agent ICI.
- Patients were categorized based on the presence or absence of visually detected emphysema on chest computed tomography (CT).
- Overall survival (OS) and progression-free survival (PFS) were compared between groups, with multivariate analysis to identify independent prognostic factors.
Main Results:
- Of 111 patients with COPD, 77 had coexisting emphysema.
- Patients with COPD and emphysema demonstrated significantly longer OS (17.3 months) compared to those without emphysema (8.5 months; p = 0.008).
- Emphysema was identified as an independent factor for better OS (hazard ratio: 0.49; 95% CI: 0.30-0.81), with similar adverse event rates across groups.
Conclusions:
- Visually detected emphysema on chest CT may serve as a valuable prognostic marker for patients with aNSCLC and COPD receiving ICIs.
- Further research is warranted to validate these findings and explore the underlying mechanisms.
- This study highlights the importance of considering emphysema in the prognostic assessment of lung cancer patients with COPD undergoing immunotherapy.
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