Impact of Chronic Obstruction Pulmonary Disease on Survival in Patients with Advanced Stage Lung Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy
Abstract
:Simple Summary
Abstract
1. Introduction
2. Patients and Methods
2.1. Study Population
2.2. Inclusion and Exclusion Criteria
2.3. Study Covariates and Statistical Analysis
3. Results
3.1. Study Cohort
3.2. Effects of COPD and Hospitalization for COPDAE on Survival Outcomes of Patients with Lung SCC Receiving Definitive CCRT
3.3. Other Independent Predictors of Overall Survival in Patients with Lung SCC Receiving Definitive CCRT
3.4. Survival Curves of COPD and Hospitalization for COPDAE in Patients with Lung SCC Receiving Definitive CCRT
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
COPD | chronic obstruction pulmonary disease |
SCC | squamous cell carcinoma |
CCRT | concurrent chemoradiotherapy |
COPDAE | COPD with acute exacerbation |
aHR | adjusted hazard ratio |
CI | confidence interval |
IPTW | inverse probability of treatment weighting |
RT | radiotherapy |
AJCC | American Joint Committee on Cancer |
RILI | radiation-induced lung injury |
RP | radiation pneumonitis |
TCRD | Taiwan Cancer Registry Database |
CCI | Charlson comorbidity index |
ICD-10-CM | International Classification of Diseases, 10th Revision, Clinical Modification |
CVD | cardiovascular disease |
AMI | acute myocardial infarction |
NTD | New Taiwan Dollar |
NCCN | National Comprehensive Cancer Network |
GOLD | Global Initiative for Chronic Obstructive Lung Disease |
References
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No COPD before CCRT N = 2767 | COPD before CCRT N = 1219 | p | |||
---|---|---|---|---|---|
N | (%) | N | (%) | ||
Age (mean ± SD) | (65.42 ± 12.90) | (73.10 ± 10.25) | <0.0001 | ||
Age | <0.0001 | ||||
Age ≤ 65 years | 1330 | 48.07% | 246 | 20.18% | |
>65 years Age ≤ 75 years | 743 | 26.85% | 390 | 31.99% | |
>75 years Age ≤ 85 years | 557 | 20.13% | 465 | 38.15% | |
Age > 85 years | 137 | 4.95% | 118 | 9.68% | |
Sex | <0.0001 | ||||
Female | 1233 | 44.56% | 243 | 19.93% | |
Male | 1534 | 55.44% | 976 | 80.07% | |
AJCC clinical stage | 0.9131 | ||||
Stage IIIA | 111 | 40.33% | 499 | 40.94% | |
Stage IIIB | 1651 | 59.67% | 720 | 59.06% | |
Histological degree of differentiation | 0.9137 | ||||
Low | 636 | 22.99% | 292 | 23.95% | |
Moderate | 1165 | 42.10% | 524 | 42.99% | |
Diabetes | 0.0041 | ||||
No | 2155 | 77.88% | 898 | 73.67% | |
Yes | 612 | 22.12% | 321 | 26.33% | |
Chronic bronchitis | <0.0001 | ||||
No | 2705 | 97.76% | 1101 | 90.32% | |
Yes | 62 | 2.24% | 118 | 9.68% | |
Asthma | <0.0001 | ||||
No | 2477 | 89.52% | 717 | 58.82% | |
Yes | 290 | 10.48% | 502 | 41.18% | |
Emphysema | 0.3231 | ||||
No | 2734 | 98.81% | 1199 | 98.36% | |
Yes | 33 | 1.19% | 20 | 1.64% | |
Cardiovascular diseases | <0.0001 | ||||
No | 1119 | 40.44% | 264 | 21.66% | |
Yes | 1648 | 59.56% | 955 | 78.34% | |
AMI | <0.0001 | ||||
No | 2703 | 97.69% | 1144 | 93.85% | |
Yes | 64 | 2.31% | 75 | 6.15% | |
Stroke | <0.0001 | ||||
No | 2624 | 94.83% | 1118 | 91.71% | |
Yes | 143 | 5.17% | 101 | 8.29% | |
CCI score | <0.0001 | ||||
0 | 2330 | 84.21% | 844 | 69.24% | |
1 | 71 | 2.57% | 49 | 4.02% | |
≥2 | 366 | 13.23% | 326 | 26.74% | |
Income level | <0.0001 | ||||
<NTD18,000 | 70 | 2.53% | 58 | 4.76% | |
NTD18,000–22,500 | 1538 | 55.58% | 769 | 63.08% | |
NTD22,500–30,000 | 726 | 26.24% | 328 | 26.91% | |
>NTD30,000 | 433 | 15.65% | 64 | 5.25% | |
Urbanization | <0.0001 | ||||
Rural | 815 | 29.45% | 437 | 35.85% | |
Urban | 1952 | 70.55% | 782 | 64.15% | |
Hospitalizations for COPDAE within 1 year before diagnosis | <0.0001 | ||||
0 | 2767 | 100.00% | 820 | 67.27% | |
1 | 0 | 0.00% | 277 | 22.72% | |
≥2 | 0 | 0.00% | 122 | 10.01% | |
Follow-up years Median (IQR, Q1, Q3) | 1.92 (0.34, 2.63) | 1.09 (0.22, 1.78) | <0.0001 | ||
All-cause death | 1885 68.12% | 938 76.95% | <0.0001 | ||
COPD death | 0 0% | 36 2.95% | <0.0001 | ||
Lung cancer death | 1790 64.69% | 891 73.10% | <0.0001 |
Crude HR (95% CI) | Adjusted HR (95% CI) * | p | |||
---|---|---|---|---|---|
COPD (ref. non-COPD) | |||||
COPD | 1.37 | (1.26, 1.51) | 1.06 | (1.07, 1.71) | 0.0311 |
Frequency of hospitalizations for COPDAE before diagnosis (ref. 0) | |||||
1 | 1.51 | (1.38, 1.74) | 1.29 | (1.16, 1.43) | <0.0001 |
≥2 | 1.97 | (1.61, 2.29) | 1.77 | (1.41, 2.13) | <0.0001 |
Age (ref. Age > 85 years) | |||||
Age ≤ 65 years | 0.38 | (0.28, 0.43) | 0.47 | (0.43, 0.57) | <0.0001 |
>65 years Age ≤ 75 years | 0.45 | (0.39, 0.51) | 0.51 | (0.39, 0.66) | <0.0001 |
>75 years Age ≤ 85 years | 0.67 | (0.59, 0.79) | 0.73 | (0.69, 0.82) | <0.0001 |
Sex (ref. Female) | |||||
Male | 1.47 | (1.39, 1.63) | 1.21 | (1.10, 1.29) | <0.0001 |
AJCC clinical stage (ref. Stage IIIA) | |||||
Stage IIIB | 1.28 | (1.06, 1.39) | 1.20 | (1.09, 1.41) | <0.0001 |
Histological degree of differentiation (ref. Low) | |||||
Moderate | 1.07 | (0.72, 1.95) | 1.17 | (1.57, 1.89) | 0.003 |
High | 1.12 | (0.63, 1.53) | 1.35 | (1.08, 1.85) | 0.009 |
CCI score (ref. 0) | |||||
1 | 1.42 | (1.199, 1.74) | 1.12 | (0.81, 1.11) | 0.3181 |
≥2 | 1.36 | (1.22, 1.61) | 1.18 | (1.07, 1.27) | <0.0001 |
Diabetes (ref. No) | |||||
Yes | 1.08 | (0.89, 1.29) | 1.06 | (0.84, 1.25) | 0.3530 |
Chronic bronchitis (ref. No) | |||||
Yes | 1.03 | (0.89, 1.07) | 1.02 | (0.83, 1.09) | 0.1911 |
Asthma (ref. No) | |||||
Yes | 1.04 | (0.87, 1.28) | 1.04 | (0.71, 1.24) | 0.2719 |
Emphysema (ref. No) | |||||
Yes | 1.11 | (0.95, 1.29) | 1.08 | (0.91, 1.29) | 0.2619 |
Cardiovascular diseases (ref. No) | |||||
Yes | 1.07 | (0.95, 1.18) | 1.04 | (0.87, 1.27) | 0.5416 |
AMI (ref. No) | |||||
1.05 | (0.90, 1.07) | 1.03 | (0.89, 1.13) | 0.3801 | |
Stroke (ref. No) | |||||
1.01 | (0.91, 1.06) | 1.00 | (0.82, 1.09) | 0.4797 | |
Income level (ref. <NTD18,000) | |||||
NTD18,000–22,500 | 0.93 | (0.71, 1.19) | 0.93 | (0.81, 1.13) | 0.2461 |
NTD22,500–30,000 | 0.81 | (0.68, 0.97) | 0.81 | (0.71, 1.11) | 0.0881 |
>NTD30,000 | 0.68 | (0.41, 0.81) | 0.61 | (0.53, 0.77) | <0.0001 |
Urbanization (ref. Rural) | |||||
Urban | 0.80 | (0.71, 0.88) | 0.79 | (0.74, 0.87) | <0.0001 |
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Chiu, K.-C.; Lin, W.-C.; Chang, C.-L.; Wu, S.-Y. Impact of Chronic Obstruction Pulmonary Disease on Survival in Patients with Advanced Stage Lung Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy. Cancers 2021, 13, 3231. https://doi.org/10.3390/cancers13133231
Chiu K-C, Lin W-C, Chang C-L, Wu S-Y. Impact of Chronic Obstruction Pulmonary Disease on Survival in Patients with Advanced Stage Lung Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy. Cancers. 2021; 13(13):3231. https://doi.org/10.3390/cancers13133231
Chicago/Turabian StyleChiu, Kuo-Chin, Wei-Chun Lin, Chia-Lun Chang, and Szu-Yuan Wu. 2021. "Impact of Chronic Obstruction Pulmonary Disease on Survival in Patients with Advanced Stage Lung Squamous Cell Carcinoma Undergoing Concurrent Chemoradiotherapy" Cancers 13, no. 13: 3231. https://doi.org/10.3390/cancers13133231