The association between cirrhosis and outcomes among patients with lung cancer in Ontario between 2007 and 2017: A...

We describe the association between cirrhosis and outcomes among patients treated for non-small cell lung cancer (NSCLC).

NSCLC cases in 2007-2017 in Ontario, Canada, were reviewed. Cirrhosis was identified using validated coding. The association between cirrhosis and outcomes was evaluated using logistic regression, Kaplan-Meier curves, and adjusted survival models.

Among patients with stage 1-3 NSCLC receiving lung resection (n = 59,226), 3% had cirrhosis with higher 30-day (5% versus 2%, p < 0.001) and 90-day (8% versus 3%, p < 0.001) mortality. After multivariable logistic regression, cirrhosis was associated with higher mortality odds at 30 days (OR 2.35, 95% CI 1.39-3.99, p < 0.001) and 90 days (OR 2.10, 95% CI 1.38-3.21, p < 0.001); higher 90-day post-operative complications odds (OR 1.44, 95% CI 1.14-1.81, p = 0.002); and higher hospital readmission odds at 30 days (OR 1.90, 95% CI 1.41-2.56, p < 0.001) and 90 days (OR 1.63, 95% CI 1.27-2.10, p = 0.001). Among those with stage 4 NSCLC (n = 27,357), adjusted Cox regression showed cirrhosis was associated with higher mortality (HR 1.10, 95% CI 1.02-1.18, p = 0.016). However, when liver-related mortality was a competing event, association between cirrhosis and cancer-specific mortality was absent (sHR 1.04, 95% CI 0.95-1.13, p = 0.395). A lower proportion of patients with cirrhosis received systemic treatments (31% versus 40%, p < 0.001), and a greater proportion experienced post-treatment complications: electrolyte disturbances (10% versus 5%, p < 0.001), kidney injury (5% versus 2%, p = 0.012), and thrombocytopenia (7% versus 2%, p < 0.001).

Cirrhosis is associated with increased morbidity and mortality in stage 1-3 NSCLC patients undergoing curative surgery. Stage 4 NSCLC patients with cirrhosis are less likely to receive palliative treatment and may experience more post-treatment complications.