Survival of Patients with Lung Cancer in the Setting of Liver Cirrhosis: A Multicenter Propensity Score Matching Study

Figures & data

Figure 1 Patient selection and matching process.

Table 1 Demographic Characteristics of Lung Cancer Patients with and without Liver Cirrhosis

Characteristic	Total (%)	Non-Cirrhosis Group	Cirrhosis Group	p-value
Number of patients	296 (100)	148 (50)	148 (50)
Age, years (median±SD)	68 ± 11.28	68 ± 10.91	68 ± 11.67	0.75
Sex				0.88
Female	58 (19.5)	30 (10.1)	28 (9.4)
Male	240 (80.5)	120 (40.3)	120 (40.3)
Smoking history				0.91
No	118 (39.6)	60 (20.1)	58 (19.5)
Yes	180 (60.4)	90 (30.2)	90 (30.2)
Creatinine, in mg/dl (median±SD)	0.95 ± 1.06	0.91 ±.0.48	0.98 ± 1.42	0.12
Albumin	3.30 ± 0.69	3.40 ± 0.66	3.24 ± 0.71	0.006
Total bilirubin	0.83 ± 1.45	0.75 ± 1.41	0.90 ± 1.50	0.23
INR	1.05 ± 0.23	1.01 ± 0.21	1.07 ± 0.25	0.057
Ascites (yes)	13 (4.4)	1 (0.3)	12 (4.1)	0.003
Encephalopathy (yes)	28 (9.5)	1 (0.3)	27 (9.1)	<0.001
MELD score	8 ± 3.52	7 ± 3.43	9 ± 3.54	0.006
Child–Pugh Score	6 ± 1.09	6 ± 1.03	6 ± 1.10	0.001
Charlson Comorbidity Index score (median±SD)	7 ± 2.63	7 ± 2.61	7 ± 2.65	0.117
Lung cancer stage				0.68
IA–IIIA	87 (28.2)	36 (12.1)	48 (16.1)
IA	18 (6)	9 (3)	9 (3)
IB	26 (8.7)	11 (3.7)	15 (5)
IIA	6 (2.0)	2 (0.7)	4 (1.3)
IIB	4 (1.3)	2 (0.7)	2 (0.7)
IIIA	30 (10.1)	12 (4)	18 (6)
IIIB–IV	214 (71.8)	114 (38.3)	100 (33.6)
IIIB	32 (10.7)	15 (5)	17 (5.7)
IV	182 (61.1)	99 (33.2)	83 (27.9)
Histology				1.00
NSCLC	263 (88.3)	132 (44.3)	131 (44)
SCLC	35 (11.7)	18 (6)	17 (5.7)
Treatment				0.58
No treatment/supportive care	51 (17.1)	24 (8.1)	27 (9.1)
Surgical treatment	67 (22.5)	31 (10.4)	36 (12.1)
OP	35 (11.7)	16 (5.4)	19 (6.4)
OP+CT	23 (7.7)	7 (2.3)	16 (5.4)
OP+CT+RT	4 (1.3)	3 (1)	1 (0.3)
OP+Target	5 (1.7)	5 (1.7)	0 (0)
Medical treatment	180 (60.4)	95 (31.9)	85 (28.5)
CT	92 (30.9)	51 (17.1)	41 (13.8)
CT+RT	37 (12.4)	16 (5.4)	21 (7)
CT+Target	6 (2)	5 (1.7)	1 (0.3)
RT	10 (3.4)	5 (1.7)	5 (1.7)
RT+Target	4 (1.3)	2 (0.7)	2 (0.7)
Target	30 (10.1)	15 (5)	15 (5)
Cryotherapy	1 (0.3)	1 (0.3)	0 (0)

Notes: The Charlson Comorbidity Index score was calculated with the exclusion of liver cirrhosis.

Abbreviations: CT, chemotherapy; INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; NSCLC, non-small cell lung cancer; OP, surgical resection; RT, radiotherapy; SCLC, small cell lung cancer; SD, standard deviation; Target, target therapy.

Table 2 Etiology of Liver Cirrhosis

	N (%)
Alcoholism	38 (25.67%)
Hepatitis B virus	42 (28.38%)
Hepatitis C virus	41 (27.70%)
Hepatitis B and C viruses	9 (6.08%)
Non-alcoholic fatty liver disease	4 (2.70%)
Unknown	14 (9.46%)

Table 3 Distribution of Cancer Histology According to Cancer Stage

	Without Cirrhosis (N)		With Cirrhosis (N)
Histological Type (N, %)	Stage IA–IIIA	Stage IIIB–IV	Stage IA–IIIA	Stage IIIB–IV
NSCLC (261, 88.2%)	34	96	46	85
Adenocarcinoma	22	59	27	46
Squamous cell carcinoma	8	22	10	24
Adenosquamous cell carcinoma	1	4	5	6
Large cell carcinoma	0	3	0	2
Sarcomatoid carcinoma	3	1	4	1
Non-small cell carcinoma	0	7	0	6
SCLC (35, 11.8%)	1	17	2	15

Abbreviations: NSCLC, non-small cell lung cancer; SCLC, small cell lung cancer.

Figure 2 Survival curve for lung cancer patients with and without cirrhosis. There was no statistically significant difference in survival for WITH-Cirrhosis and WITHOUT-Cirrhosis lung cancer patients. The median overall survival for patients WITH-Cirrhosis was 13.07 months (95% CI 10.56–16.84) compared to 13.67 months (95% CI 10.42–16.91) for patients WITHOUT-Cirrhosis, p=0.76.

Table 4 Adjusted Cox Proportional Hazards Regression Analysis for Survival

	Adjusted Hazard Ratio	95% CI	p-value
Liver cirrhosis
No	Ref
Yes	1.057	0.805–1.388	0.690
Age	1.001	0.988–1.014	0.901
Sex
Female	Ref
Male	0.878	0.573–1.346	0.550
Smoking history
No	Ref
Yes	1.113	0.797–1.554	0.529
Creatinine	1.076	0.907–1.277	0.400
Albumin	0.700	0.494–0.993	0.045
Total bilirubin	0.983	0.862–1.121	0.799
INR	1.645	0.841–3.217	0.146
Ascites
No	Ref
Yes	0.933	0.430–2.026	0.862
Encephalopathy
No	Ref
Yes	0.947	0.502–1.787	0.866
MELD score	1.021	0.958–1.088	0.530
Child–Pugh Score	1.083	0.838–1.398	0.543
Charlson Comorbidity Index score	1.090	1.023–1.161	0.007
Stage
IA–IIIA	Ref
IIIB–IV	0.607	0.390–0.944	0.027
Histology
NSCLC	Ref
SCLC	0.748	0.504–1.109	0.149
Treatment
Supportive	1.737	1.204–2.505	0.003
Medical	Ref
Surgical	0.502	0.288–0.874	0.015

Notes: The Charlson Comorbidity Index score was calculated with the exclusion of liver cirrhosis. Serum albumin level, Charlson Comorbidity Index score, advanced-stage lung cancer, and treatment modality were independent factors associated with poor outcomes in patients for with cirrhosis. Increase in serum albumin by 1 g was associated with a 30% reduction in the risk of mortality (HR: 0.700, 95% CI: 0.494–0.993, p=0.045). Increase in the Charlson Comorbidity Index score by 1 point was linked to a 9% higher risk of mortality (HR: 1.090, 95% CI: 1.023–1.161, p=0.007). Using medical treatment as a reference, surgical treatment improved the chance of survival by 50% (HR: 0.502, 95% CI: 0.288–0.874, p=0.015).

Abbreviations: CI, confidence interval; HR, hazard ratio; INR, international normalized ratio; MELD, Model for End-Stage Liver Disease; NSCLC, non-small cell lung cancer; SCLC, small cell lung cancer.