Lung Cancer in Patients With COPD: Predictors of Surgery and Long-Term Survival Following Lung Resection

Lung resection is the preferred treatment option for lung cancer. Patients with chronic obstructive pulmonary disease (COPD) may be denied surgery due to lung function impairment or other comorbidities.

We aimed to describe the predictors of lung resection and long-term survival in patients with COPD with early-stage nonsmall cell lung cancer (NSCLC).

This is a retrospective cohort study of patients with COPD who were treated for resectable NSCLC between 2009 and 2019 in a tertiary care hospital. The decision to operate or not followed a thorough clinical evaluation. Survival status was obtained from a provincial registry. A multivariable logistic regression analysis was used to determine predictors of surgery. A propensity score technique was used to control for confounding by indication. Hazard ratios for survival were estimated from a Cox regression model, adjusted for measured baseline confounders and propensity score as covariates.

A total of 1307 patients with COPD were included, including 918 who underwent surgery. Of those, 147 (38%) did not have surgery and were treated with stereotactic body radiotherapy, 86 (22%) were treated with conventional radiotherapy, and 156 (40%) did not receive any active treatment. Predictors of surgery included age, forced expiratory volume in 1 second, adenocarcinoma versus squamous cell carcinoma, and stage 2A versus stage 1A. Propensity score-adjusted survival was significantly reduced with nonsurgical versus surgical approaches.

Lung resection was associated with better survival in patients with COPD and resectable lung cancer compared to nonsurgical approaches.