Hsu Li-Han, Lin Yi-Hsuan, Feng An-Chen, Chu Nei-Min, Kao Shu-Huei
Division of Pulmonary and Critical Care Medicine, Sun Yat-Sen Cancer Center, No. 125, Lih-Der Road, Pei-Tou District, Taipei 11259, Taiwan.
School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Ther Adv Med Oncol. 2025 Jul 10;17:17588359251355412. doi: 10.1177/17588359251355412. eCollection 2025.
Chronic airway inflammation in asthma and/or chronic obstructive pulmonary disease (COPD) is presumed to be protumorigenic. The tumor inhibitory effect of inhaled corticosteroids (ICSs) used to reduce airway inflammation in patients with asthma and COPD remains unclear.
This study aimed to evaluate the impact of coexisting asthma and/or COPD on the survival of patients with lung adenocarcinoma. The effects of ICS treatment were also assessed.
This retrospective, real-world cohort study was conducted at a cancer center.
The overall survival of a cohort of 1524 consecutive patients with lung adenocarcinoma who were enrolled between January 2011 and December 2019 and followed up until December 2022 was analyzed, followed by subgroup comparisons.
A total of 283 patients had coexisting asthma and/or COPD. Among them, 212 had used ICSs. ICS users were predominantly women, older, and had more advanced-stage disease; moreover, there were fewer tobacco smokers, fewer comorbidities, and relatively severe obstructive impairments than non-ICS users. When restricted to stage 0-II diseases, patients with coexisting asthma and/or COPD had a lower 5-year overall survival rate (77% vs 90%, < 0.001), with a hazard ratio of 1.8, in contrast to no difference among patients with stage III-IV disease. ICS users had a lower 5-year overall survival rate in both subgroups, although the difference was not statistically significant.
The impact of cancer on prognosis may overwhelm the effects of asthma and/or COPD in patients with advanced-stage lung adenocarcinoma. The evaluation of the effects of ICS treatment appears to be confounded by intent and compliance, which can introduce bias in the opposite direction. However, investigating the treatment effects on asthma and/or COPD control would be beneficial. A systematic prospective study is required to define the role of the ICS.
哮喘和/或慢性阻塞性肺疾病（COPD）中的慢性气道炎症被认为具有促肿瘤作用。用于减轻哮喘和COPD患者气道炎症的吸入性糖皮质激素（ICS）的肿瘤抑制作用仍不清楚。
本研究旨在评估合并哮喘和/或COPD对肺腺癌患者生存的影响。还评估了ICS治疗的效果。
本回顾性、真实世界队列研究在一家癌症中心进行。
分析了2011年1月至2019年12月期间连续入组的1524例肺腺癌患者的总生存期，并随访至2022年12月，随后进行亚组比较。
共有283例患者合并哮喘和/或COPD。其中，212例使用过ICS。使用ICS的患者以女性居多，年龄较大，疾病分期更晚；此外，与未使用ICS的患者相比，吸烟者更少，合并症更少，阻塞性损害相对更严重。当仅限于0-II期疾病时，合并哮喘和/或COPD的患者5年总生存率较低（77%对90%，<0.001），风险比为1.8，而III-IV期疾病患者之间无差异。在两个亚组中，使用ICS的患者5年总生存率均较低，尽管差异无统计学意义。
癌症对预后的影响可能超过晚期肺腺癌患者中哮喘和/或COPD的影响。ICS治疗效果的评估似乎因治疗意图和依从性而混淆，这可能会引入相反方向的偏差。然而，研究治疗对哮喘和/或COPD控制的效果将是有益的。需要进行系统的前瞻性研究来确定ICS的作用。
