COPD in primary lung cancer patients: prevalence and mortality

Figures & data

Table 1 Baseline characteristics, means, and standard deviation of lung cancer patients diagnosed at the University Hospital of North Norway in 2008–2010 (n=174) according to presence of COPD and emphysema

Patient group	All		COPD		Emphysema without COPD		Neither COPD nor emphysema
n	174		67		53		54
% male	58		59.7		66		48.1
n, cancer stage I + II	35		16		11		8
n, cancer stage III + IV	138		51		42		45
	Mean	SD	Mean	SD	Mean	SD	Mean	SD
Age (years), n=174	67.92	10.17	70.73	8.52	67.58	9.47	64.76	11.80
BMI (kg/m^2), n=155	24.97	5.01	25.31	5.23	23.35	4.47	25.93	4.92
FVC (L), n=144	2.62	0.84	2.40	0.75	2.74	0.94	2.81	0.81
FVC (%) predicted	78.70	20.21	73.38	17.29	80.56	22.52	84.43	20.40
FEV1 (L), n=144	1.83	0.67	1.48	0.50	1.99	0.65	2.18	0.67
FEV1 (%) predicted	69.05	21.08	57.50	16.75	74.59	20.87	80.41	18.77
FEV1/FVC (%), n=144	70.17	12.68	62.46	12.05	73.85	11.15	77.61	8.29
PaO2 (kPa, air), n=151	9.93	1.58	9.56	1.34	9.70	1.56	10.65	1.68
PaCO2 (kPa, air), n=151	5.10	0.68	5.22	0.57	5.14	0.86	4.89	0.62
COHb (%), n=144	1.49	1.12	1.40	0.82	1.68	1.40	1.44	1.21
Tumor size (cm)
All patients, n=167	5.13	2.46	5.32	2.55	5.27	2.69	4.73	2.04
Females, n=68	4.73	2.26	4.84	2.16	4.64	2.68	4.67	2.12

Abbreviations: BMI, body mass index; FVC, forced vital capacity; FEV₁, forced expiratory volume in 1 second; PaO₂, partial arterial oxygen pressure; COHb, carboxyhemoglobin (in arterial blood plasma); PaCO₂, partial arterial carbon dioxide pressure.

Figure 1 Prevalence of COPD and emphysema by histologic type of primary lung cancer (n=168).

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

Table 2 Impact of evaluated variables on survival of patients with primary lung cancer according to Cox regression analysis (n=144)

Variables	Category	HR	95% CI	P-value
Age (reference <75 years)	≥75 years	2.48	1.59–3.87	0.0001
Sex	Female	0.63	0.42–0.94	0.0239
COPD (reference no – COPD)	Known – COPD	1.02	0.65–1.60	0.9388
	Undiagnosed – COPD	1.02	0.47–2.23	0.9609
	Missing – spirometry	6.33	2.69–14.93	<0.0001
Histologic type (reference SCLC)	Adenocarcinoma – NSCLC	1.30	0.78–2.15	0.3157
	SCC – NSCLC	0.99	0.57–1.71	0.9679
	Other – NSCLC	4.19	1.56–11.25	0.0045
PaO2 (kPa, air), reference ≥10	4.0–8.4	2.26	1.29–3.96	0.0045
	8.5–9.9	1.44	0.91–2.28	0.1172
PaCO2 (kPa, air), reference 5.0–5.9
Stage I	3–4.9	1.69	0.31–9.34	0.5456
	6–10	11.24	2.64–47.85	0.0011
Stage II	3–4.9	1.70	0.47–6.21	0.4226
	6–10	19.97	1.92–208.06	0.0123
Stage III	3–4.9	1.58	0.77–3.22	0.2096
	6–10	0.76	0.22–2.64	0.6644
Stage IV	3–4.9	2.23	1.29–3.85	0.0040
	6–10	0.28	0.07–1.06	0.0611

Note: Patients with missing data were categorized as “missing – spirometry”.

Abbreviations: HR, hazard ratio; CI, confidence interval; NSCLC, non-small-cell lung cancer; SCC, squamous cell carcinoma; PaO₂, partial arterial oxygen pressure; SCLC, small-cell lung cancer; PaCO₂, partial arterial carbon dioxide pressure.

Figure 2 Survival curves for primary lung cancer (except other – NSCLC) by stage among males and females younger than 75 years.

Note: PaO₂ fixed at ≥10, PaCO₂ at 5.0–5.9 kPa.

Abbreviations: NSCLC, non-small-cell lung cancer; PaO₂, partial arterial oxygen pressure; PaCO₂, partial arterial carbon dioxide pressure.

Figure 3 Survival curve for primary lung cancer (except other – NSCLC) stage III by age, sex, and spirometry.

Notes: PaO₂ fixed at ≥10, PaCO₂ at 5.0–5.9 kPa. Patients with missing data were categorized as “missing – spirometry”.
Abbreviations: NSCLC, non-small-cell lung cancer; PaO₂, partial arterial oxygen pressure; PaCO₂, partial arterial carbon dioxide pressure.

Table S1 Survival of primary lung cancer of all 174 patients diagnosed at University Hospital of North Norway 2008–2010

ID	Sex	Age-group, years	COPD diagnosis	Emph	PaO2, range	PaCO2, range	Cancer	Stage	Time	D
1	F	30–74	No COPD	0	10–15	3–4.9	Ad-NSCLC	III	377	1
2	M	30–74	Missing – spirometry	0	NA	NA	SCC – NSCLC	IV	340	1
3	M	30–74	No COPD	1	10–15	3–4.9	SCLC	IV	157	1
4	M	30–74	No COPD	0	10–15	3–4.9	SCLC	IV	547	1
5	M	30–74	No COPD	0	10–15	5–5.9	Ad-NSCLC	IV	2,067	1
6	M	30–74	No COPD	0	10–15	5–5.9	SCC – NSCLC	III	1,243	1
7	M	30–74	No COPD	0	10–15	3–4.9	SCC – NSCLC	III	279	1
8	M	30–74	Known COPD	1	4–8.4	5–5.9	SCLC	III	365	1
9	F	75–91	Known COPD	0	10–15	5–5.9	SCLC	III	620	1
10	M	75–91	Known COPD	0	8.5–9.9	3–4.9	SCLC	IV	16	1
11	F	30–74	No COPD	0	10–15	3–4.9	Other – NSCLC	I	803	1
12	M	75–91	No COPD	1	4–8.4	5–5.9	SCLC	IV	77	1
13	F	30–74	No COPD	0	10–15	5–5.9	Ad-NSCLC	I	353	1
14	M	30–74	No COPD	1	10–15	3–4.9	SCLC	IV	188	1
15	M	30–74	No COPD	0	10–15	5–5.9	SCC – NSCLC	II	289	1
16	F	30–74	No COPD	1	4–8.4	6–10	SCC – NSCLC	III	2,175	1
17	M	30–74	Missing – spirometry	0	10–15	5–5.9	SCC – NSCLC	IV	104	1
18	M	75–91	Missing – spirometry	1	4–8.4	3–4.9	NA	IV	10	1
19	M	30–74	No COPD	0	10–15	3–4.9	Other – NSCLC	IV	41	1
20	M	30–74	No COPD	0	10–15	3–4.9	SCLC	NA	155	1
21	F	30–74	No COPD	0	8.5–9.9	5–5.9	Ad-NSCLC	IV	245	1
22	M	30–74	No COPD	0	10–15	5–5.9	SCC – NSCLC	IV	116	1
23	F	30–74	No COPD	1	10–15	3–4.9	Ad-NSCLC	IV	131	1
24	M	30–74	Known COPD	1	4–8.4	3–4.9	Ad-NSCLC	IV	287	1
25	M	75–91	No COPD	1	10–15	5–5.9	SCC – NSCLC	IV	45	1
26	F	30–74	No COPD	0	10–15	3–4.9	Ad-NSCLC	III	1,787	1
27	M	75–91	Undiagnosed COPD	1	8.5–9.9	5–5.9	SCC – NSCLC	IV	52	1
28	F	30–74	Missing – spirometry	1	4–8.4	5–5.9	SCC – NSCLC	IV	54	1
29	M	30–74	No COPD	0	10–15	3–4.9	NA	IV	162	1
30	M	75–91	Known COPD	1	4–8.4	6–10	SCC – NSCLC	IV	319	1
31	F	30–74	No COPD	0	10–15	3–4.9	Ad-NSCLC	IV	561	1
32	M	30–74	Known COPD	1	4–8.4	5–5.9	SCLC	IV	1,076	1
33	M	30–74	Missing – spirometry	1	NA	NA	SCC – NSCLC	III	91	1
34	M	75–91	Known COPD	0	10–15	5–5.9	SCLC	III	27	1
35	M	75–91	No COPD	0	10–15	3–4.9	SCLC	IV	7	1
36	F	30–74	No COPD	0	4–8.4	5–5.9	Ad-NSCLC	IV	76	1
37	F	75–91	No COPD	0	10–15	3–4.9	Ad-NSCLC	II	192	1
38	F	75–91	No COPD	1	10–15	3–4.9	SCC – NSCLC	II	370	1
39	F	30–74	No COPD	1	8.5–9.9	6–10	Ad-NSCLC	I	377	1
40	M	75–91	Missing – spirometry	0	10–15	5–5.9	SCC – NSCLC	IV	36	1
41	F	30–74	Known COPD	0	10–15	5–5.9	Other – NSCLC	III	33	1
42	M	30–74	Known COPD	0	4–8.4	5–5.9	SCLC	III	1,461	1
43	M	30–74	No COPD	1	10–15	3–4.9	Other – NSCLC	IV	141	1
44	F	30–74	Missing – spirometry	1	NA	NA	SCC – NSCLC	III	28	1
45	F	30–74	No COPD	0	8.5–9.9	5–5.9	Ad-NSCLC	IV	576	1
46	F	30–74	Missing – spirometry	1	4–8.4	5–5.9	SCLC	IV	130	1
47	M	30–74	Known COPD	1	4–8.4	5–5.9	Ad-NSCLC	III	38	1
48	F	75–91	No COPD	1	10–15	3–4.9	Ad-NSCLC	IV	44	1
49	M	30–74	No COPD	1	10–15	5–5.9	Ad-NSCLC	I	2,298	0
50	M	30–74	No COPD	0	10–15	6–10	Ad-NSCLC	III	132	1
51	M	30–74	Undiagnosed COPD	1	8.5–9.9	5–5.9	Ad-NSCLC	III	83	1
52	M	30–74	No COPD	1	10–15	3–4.9	Ad-NSCLC	III	204	1
53	M	30–74	No COPD	1	8.5–9.9	5–5.9	SCLC	IV	166	1
54	F	75–91	Undiagnosed COPD	0	8.5–9.9	6–10	SCC – NSCLC	II	50	1
55	F	30–74	No COPD	0	10–15	5–5.9	SCLC	IV	175	1
56	M	75–91	No COPD	1	8.5–9.9	3–4.9	SCC – NSCLC	III	28	1
57	M	30–74	Undiagnosed COPD	1	10–15	5–5.9	SCC – NSCLC	I	2,155	1
58	M	30–74	Known COPD	0	10–15	3–4.9	Other – NSCLC	IV	168	1
59	F	30–74	Missing – spirometry	0	4–8.4	3–4.9	Ad-NSCLC	IV	2	1
60	M	75–91	Known COPD	0	10–15	5–5.9	SCC – NSCLC	III	415	1
61	M	30–74	No COPD	0	10–15	5–5.9	Ad-NSCLC	IV	917	1
62	M	30–74	Known COPD	1	10–15	5–5.9	SCC – NSCLC	III	475	1
63	F	30–74	No COPD	0	8.5–9.9	5–5.9	SCLC	IV	1,485	1
64	M	30–74	Known COPD	1	4–8.4	3–4.9	SCLC	III	13	1
65	M	75–91	Undiagnosed COPD	1	8.5–9.9	3–4.9	SCC – NSCLC	III	460	1
66	F	30–74	No COPD	0	NA	NA	Ad-NSCLC	III	698	1
67	M	30–74	Known COPD	1	4–8.4	5–5.9	Ad-NSCLC	IV	226	1
68	M	30–74	No COPD	0	8.5–9.9	5–5.9	Ad-NSCLC	IV	184	1
69	F	30–74	No COPD	1	10–15	5–5.9	Ad-NSCLC	I	2,196	0
70	F	30–74	No COPD	0	10–15	5–5.9	Ad-NSCLC	III	265	1
71	F	30–74	No COPD	1	8.5–9.9	3–4.9	SCC – NSCLC	II	2,189	0
72	M	30–74	No COPD	1	10–15	3–4.9	SCC – NSCLC	III	287	1
73	M	30–74	Known COPD	1	8.5–9.9	5–5.9	SCLC	IV	492	1
74	M	30–74	Missing – spirometry	0	8.5–9.9	6–10	SCC – NSCLC	IV	501	1
75	F	30–74	No COPD	0	8.5–9.9	5–5.9	Ad-NSCLC	II	1,758	1
76	M	30–74	No COPD	0	10–15	5–5.9	SCC – NSCLC	III	432	1
77	F	30–74	No COPD	0	10–15	5–5.9	SCLC	III	2,142	0
78	M	30–74	No COPD	1	NA	NA	SCC – NSCLC	II	2,141	0
79	M	30–74	No COPD	1	8.5–9.9	3–4.9	SCLC	IV	18	1
80	F	30–74	Missing – spirometry	0	10–15	3–4.9	SCLC	IV	19	1
81	M	75–91	Missing – spirometry	0	NA	NA	SCLC	IV	35	1
82	F	30–74	Missing – spirometry	0	8.5–9.9	3–4.9	SCC – NSCLC	IV	135	1
83	F	30–74	Known COPD	1	4–8.4	3–4.9	SCLC	IV	111	1
84	F	30–74	Known COPD	0	NA	NA	SCLC	IV	58	1
85	F	30–74	Undiagnosed COPD	1	10–15	5–5.9	SCC – NSCLC	III	2,114	0
86	F	30–74	No COPD	0	NA	NA	Ad-NSCLC	III	254	1
87	M	75–91	Missing – spirometry	1	NA	NA	SCLC	IV	35	1
88	F	75–91	No COPD	0	4–8.4	3–4.9	Ad-NSCLC	IV	18	1
89	M	75–91	Known COPD	1	10–15	3–4.9	SCLC	II	417	1
90	M	30–74	Known COPD	1	10–15	5–5.9	Ad-NSCLC	I	249	1
91	F	30–74	Known COPD	1	4–8.4	6–10	Ad-NSCLC	III	630	1
92	F	30–74	Undiagnosed COPD	0	10–15	3–4.9	Ad-NSCLC	IV	22	1
93	M	30–74	No COPD	1	10–15	5–5.9	Ad-NSCLC	III	728	1
94	M	75–91	No COPD	1	8.5–9.9	3–4.9	NA	III	171	1
95	F	30–74	Known COPD	0	8.5–9.9	5–5.9	SCLC	IV	512	1
96	F	30–74	Missing – spirometry	1	NA	NA	Ad-NSCLC	IV	455	1
97	M	30–74	Known COPD	0	10–15	5–5.9	SCLC	III	441	1
98	F	75–91	Known COPD	1	4–8.4	5–5.9	SCC – NSCLC	I	1,329	1
99	M	75–91	Known COPD	1	4–8.4	3–4.9	SCC – NSCLC	III	163	1
100	F	30–74	No COPD	0	10–15	3–4.9	SCLC	I	1,902	0
101	F	75–91	No COPD	0	10–15	3–4.9	Ad-NSCLC	IV	537	1
102	F	75–91	No COPD	0	8.5–9.9	5–5.9	NA	IV	345	1
103	F	75–91	Undiagnosed COPD	0	4–8.4	5–5.9	Ad-NSCLC	IV	159	1
104	M	75–91	Missing – spirometry	0	NA	NA	NA	IV	14	1
105	M	30–74	No COPD	0	8.5–9.9	5–5.9	SCLC	I	1,983	0
106	M	75–91	Known COPD	1	8.5–9.9	5–5.9	SCC – NSCLC	II	526	1
107	M	30–74	Missing – spirometry	1	NA	NA	Ad-NSCLC	IV	222	1
108	F	75–91	Known COPD	1	NA	NA	Ad-NSCLC	IV	82	1
109	M	75–91	Known COPD	0	8.5–9.9	5–5.9	Ad-NSCLC	IV	168	1
110	F	75–91	Known COPD	1	4–8.4	5–5.9	SCC – NSCLC	III	197	1
111	M	30–74	No COPD	0	NA	NA	Ad-NSCLC	IV	1,412	1
112	F	30–74	No COPD	0	10–15	5–5.9	SCC – NSCLC	IV	1,092	1
113	M	75–91	No COPD	1	8.5–9.9	3–4.9	SCC – NSCLC	II	195	1
114	M	30–74	Known COPD	1	10–15	5–5.9	SCLC	IV	990	1
115	F	75–91	No COPD	1	10–15	5–5.9	Ad-NSCLC	I	1,254	1
116	M	30–74	No COPD	1	8.5–9.9	3–4.9	SCC – NSCLC	III	789	1
117	F	30–74	Undiagnosed COPD	1	10–15	5–5.9	Ad-NSCLC	II	1,892	0
118	F	75–91	Known COPD	1	8.5–9.9	3–4.9	SCLC	I	921	1
119	F	30–74	Known COPD	1	4–8.4	5–5.9	SCC – NSCLC	III	618	1
120	M	30–74	Undiagnosed COPD	0	10–15	5–5.9	SCLC	I	1,875	0
121	F	30–74	Known COPD	1	8.5–9.9	3–4.9	SCC – NSCLC	III	69	1
122	M	30–74	Undiagnosed COPD	1	4–8.4	3–4.9	Ad-NSCLC	IV	16	1
123	F	30–74	No COPD	1	10–15	3–4.9	Ad-NSCLC	IV	181	1
124	M	75–91	Known COPD	1	10–15	3–4.9	SCC – NSCLC	IV	81	1
125	M	30–74	Known COPD	1	10–15	3–4.9	Ad-NSCLC	III	195	1
126	M	30–74	No COPD	1	10–15	3–4.9	SCC – NSCLC	III	471	1
127	F	30–74	Known COPD	1	8.5–9.9	6–10	SCC – NSCLC	III	92	1
128	M	30–74	No COPD	1	8.5–9.9	3–4.9	SCLC	IV	3	1
129	M	30–74	No COPD	1	8.5–9.9	5–5.9	SCC – NSCLC	IV	153	1
130	M	30–74	Known COPD	1	10–15	6–10	SCC – NSCLC	I	555	1
131	M	30–74	Known COPD	1	10–15	3–4.9	Ad-NSCLC	III	148	1
132	M	75–91	No COPD	1	NA	NA	Ad-NSCLC	I	1,847	0
133	M	30–74	Known COPD	1	10–15	5–5.9	SCC – NSCLC	III	417	1
134	M	30–74	No COPD	1	10–15	5–5.9	SCC – NSCLC	I	1,840	0
135	M	30–74	No COPD	1	10–15	5–5.9	SCC – NSCLC	II	1,875	0
136	F	30–74	No COPD	1	NA	NA	Ad-NSCLC	III	776	1
137	M	30–74	No COPD	1	4–8.4	3–4.9	Ad-NSCLC	IV	14	1
138	F	30–74	Undiagnosed COPD	1	10–15	3–4.9	SCLC	IV	437	1
139	F	30–74	Known COPD	1	10–15	3–4.9	Ad-NSCLC	III	1,818	0
140	M	75–91	No COPD	1	8.5–9.9	5–5.9	SCLC	III	924	1
141	M	75–91	Known COPD	1	10–15	5–5.9	SCC – NSCLC	I	1,797	0
142	M	30–74	Known COPD	0	8.5–9.9	3–4.9	SCC – NSCLC	IV	214	1
143	F	30–74	Known COPD	1	8.5–9.9	5–5.9	SCC – NSCLC	I	1,744	0
144	M	75–91	Missing – spirometry	1	8.5–9.9	5–5.9	SCC – NSCLC	III	701	1
145	M	30–74	No COPD	0	10–15	3–4.9	Ad-NSCLC	IV	278	1
146	M	75–91	Known COPD	1	10–15	3–4.9	Ad-NSCLC	IV	397	1
147	M	30–74	No COPD	1	10–15	5–5.9	SCLC	III	176	1
148	M	30–74	Missing – spirometry	1	4–8.4	5–5.9	Ad-NSCLC	IV	37	1
149	M	30–74	Known COPD	0	10–15	5–5.9	Ad-NSCLC	IV	290	1
150	F	30–74	Known COPD	1	8.5–9.9	5–5.9	NA	III	249	1
151	M	30–74	Missing – spirometry	1	NA	NA	Ad-NSCLC	IV	131	1
152	F	30–74	No COPD	1	NA	NA	SCLC	IV	288	1
153	M	75–91	Known COPD	1	10–15	6–10	SCC – NSCLC	I	98	1
154	F	30–74	No COPD	0	10–15	5–5.9	Ad-NSCLC	III	1,747	0
155	M	30–74	Known COPD	1	8.5–9.9	5–5.9	SCC – NSCLC	III	741	1
156	M	75–91	Missing – spirometry	1	NA	NA	SCLC	IV	184	1
157	F	30–74	No COPD	1	8.5–9.9	5–5.9	SCLC	IV	398	1
158	M	30–74	No COPD	0	10–15	5–5.9	SCLC	IV	449	1
159	M	30–74	No COPD	0	10–15	3–4.9	Ad-NSCLC	II	1,437	1
160	F	30–74	No COPD	0	10–15	3–4.9	Ad-NSCLC	IV	166	1
161	M	30–74	No COPD	1	8.5–9.9	3–4.9	Ad-NSCLC	IV	141	1
162	M	30–74	No COPD	0	10–15	3–4.9	SCC – NSCLC	III	1,001	1
163	F	30–74	Missing – spirometry	1	10–15	5–5.9	SCLC	IV	181	1
164	F	75–91	Known COPD	1	10–15	5–5.9	Ad-NSCLC	II	335	1
165	F	30–74	Missing – spirometry	0	NA	NA	SCC – NSCLC	IV	236	1
166	F	75–91	Known COPD	1	8.5–9.9	5–5.9	Other – NSCLC	IV	68	1
167	M	30–74	Known COPD	1	8.5–9.9	6–10	Ad-NSCLC	IV	9	1
168	M	30–74	Known COPD	1	4–8.4	5–5.9	SCLC	I	445	1
169	F	30–74	No COPD	0	NA	NA	SCLC	III	514	1
170	F	30–74	Known COPD	0	NA	NA	SCLC	IV	333	1
171	F	30–74	Known COPD	1	10–15	3–4.9	Ad-NSCLC	II	243	1
172	F	30–74	Known COPD	1	4–8.4	5–5.9	SCLC	IV	244	1
173	F	30–74	No COPD	1	10–15	5–5.9	SCC – NSCLC	III	632	1
174	M	30–74	Missing – spirometry	1	NA	NA	Ad-NSCLC	IV	57	1

Notes: Time represents survival time (days) from diagnosis of primary lung cancer; D represents a censoring variable (1 if dead, 0 if alive at the end of the study period); PaO₂ and PaCO₂ in kPa. Patients with missing data were categorized as “missing – spirometry”.

Abbreviations: Ad-NSCLC, adenocarcinoma non-small-cell lung cancer; Emph, emphysema; F, female; M, male; NA, not available; PaO₂, partial arterial oxygen pressure; SCC, squamous cell carcinoma; SCLC, small-cell lung cancer; PaCO₂, partial arterial carbon dioxide pressure.