COPD Severity as an Independent Predictor of Long-Term Survival in Operable Lung Cancer: A Retrospective Analysis from a High-Volume Thoracic Surgery Center.

PURPOSE

This study aims to identify predictors of long-term survival in patients with chronic obstructive pulmonary disease (COPD) undergoing anatomical resections for non-small cell lung cancer (NSCLC), with focus on COPD severity, to improve perioperative risk stratification and patient care.

PATIENTS AND METHODS

This retrospective study included all patients with NSCLC and COPD undergoing anatomical resections at the Lung Tumor Center Munich between 2011 and 2020. COPD severity was classified by Global Initiative for Obstructive Lung Disease criteria: Group 1 (mild/moderate obstruction, COPD I-II) and Group 2 (severe obstruction, COPD III-IV). The relationship between COPD severity and perioperative parameters was analyzed using Kaplan-Meier and Cox proportional hazard model.

RESULTS

Of 1663 NSCLC patients undergoing anatomical resections, 476 (28.6%) patients with COPD I-IV (40.5% female, median age 67.28 [60.57; 73.27] years) were included. No significant differences were observed between groups in demographics, topography, TNM classification, histology of the primary tumor, and surgical approach. Group 2 experienced more frequently prolonged mechanical ventilation >2 days (p=0.016), air leaks >5 days (p = 0.020), and arrhythmias (p=0.012). Median overall survival (OS) was reduced in Group 2 (43.73 [30.14; 57.33] vs 85.30 [67.46; 103.14] months, p=0.001). Independent predictors of reduced OS included COPD III-IV (p<0.0001), pT (p=0.007), pN (p<0.0001), preoperative CRP >0.6 mg/dL (p=0.014) and VOmax <17 mL/min/kg (p=0.040). These predictors increased the risk of death by 1.6 [1.27-1.90], 1.3 [1.06-1.48], 2.1 [1.49-3.03], 1.6 [1.09-2.20] and 1. [1.02-2.00] fold, respectively.

CONCLUSION

COPD severity independently predicts perioperative morbidity and long-term survival in operable NSCLC patients. Comprehensive assessment of COPD severity can help in identifying high-risk patients and optimizing perioperative care.