Survival associated with chronic obstructive pulmonary disease among SEER-Medicare beneficiaries with non-small-cell lung cancer

Figures & data

Table 1 Characteristics of non-small-cell lung cancer patients with preexisting COPD by COPD subtype

Covariate	Chronic bronchitis, n (%)	Emphysema, n (%)	No COPD, n (%)	Total, n (%)	P-value
No of patients	11,221 (18.97)	3,475 (5.87)	44,466 (75.15)	59,162
Sex					0.45
Males	5,809 (51.77)	1,787 (51.42)	22,715 (51.08)	30,311 (51.23)
Females	5,412 (48.23)	1,688 (48.58)	21,751 (48.92)	28,851 (48.76)
Race					<0.0001
White	10,315 (91.93)	3,024 (87.02)	38,447 (86.46)	51,786 (87.53)
Black	720 (6.42)	343 (9.87)	3,692 (8.30)	4,755 (8.03)
American Indian	36 (0.32)	3 (0.09)	126 (0.28)	165 (0.27)
Asian	137 (1.22)	96 (2.76)	2,128 (4.79)	2,361 (3.99)
Other	15 (0.13)	13 (0.37)	73 (0.16)	101 (0.17)
Age mean (SD)	74.73 (6.39)	74.71 (6.35)	75.42 (6.94)		<0.0001
Age group (years)					<0.0001
66–69	2,449 (21.83)	743 (21.38)	9,461 (21.28)	12,653 (21.38)
70–73	2,411 (21.49)	633 (18.22)	8,429 (18.96)	11,473 (19.39)
74–79	3,314 (29.53)	1,098 (31.60)	12,389 (27.86)	16,801 (28.39)
80+	3,047 (27.15)	1,001 (28.81)	14,187 (31.91)	18,235 (30.82)
Comorbidities
Myocardial infarction	410 (3.65)	143 (4.12)	1,878 (4.22)	2,431	0.027
Congestive heart failure	1,527 (13.61)	344 (9.90)	3,829 (8.61)	5,700	<0.0001
Peripheral vascular disease	599 (5.34)	202 (5.81)	2,014 (4.53)	2,815	<0.0001
Cerebrovascular disease	445 (3.97)	162 (4.66)	2,263 (5.09)	2,870	<0.0001
Dementia	104 (0.93)	27 (0.78)	650 (1.46)	781	<0.0001
Asthma	278 (2.48)	110 (3.17)	1,287 (2.98)	1,675	0.03
Connective tissue disease	132 (1.18)	48 (1.38)	643 (1.45)	823	0.09
Peptic ulcer	89 (0.79)	29 (0.83)	419 (0.94)	537	0.31
Mild liver disease	81 (0.72)	29 (0.83)	529 (1.19)	639	<0.0001
Diabetes mellitus	1,170 (10.43)	320 (9.21)	5,207 (11.71)	6,697	<0.0001
Diabetes mellitus with complications	85 (0.76)	30 (0.86)	366 (0.82)	481	0.76
Hemiplegia	49 (0.44)	18 (0.52)	373 (0.84)	440	<0.0001
Renal disease	486 (4.33)	127 (3.65)	1,713 (3.85)	2,326	0.04
Severe liver disease	19 (0.17)	13 (0.37)	130 (0.29)	162	0.009
Charlson’s comorbidity score					<0.0001
0 to 2	10,676 (95.14)	3,306 (95.13)	42,785 (96.22)	56,787
3 to 5	529 (4.71)	155 (4.46)	1,650 (3.71)	2,334
>5	16 (0.14)	14 (0.40)	31 (0.07)	61
Tumor grade					<0.0001
Well differentiated	340 (3.03)	147 (4.23)	1,847 (4.15)	2,334
Moderately differentiated	1,476 (13.15)	529 (15.22)	6,122 (13.77)	8,127
Poorly differentiated	2,420 (21.57)	789 (22.71)	9,665 (21.74)	12,874
Undifferentiated	567 (5.05)	182 (5.24)	2,126 (4.78)	2,875
Unknown	6,418 (57.19)	1,828 (52.61)	24,706 (55.80)	32,952
Stage (TNM)					<0.0001
Stage I	2,402 (21.41)	766 (22.04)	7,184 (16.16)	10,352
Stage II	539 (4.80)	171 (4.92)	2,282 (5.13)	2,992
Stage IIIA	986 (8.79)	284 (8.17)	3,417 (7.68)	4,687
Stage IIIB	1,731 (15.43)	505 (14.53)	6,680 (15.02)	8,916
Stage IV	4,116 (36.68)	1,398 (40.23)	19,675 (44.25)	25,189
Unknown	1,447 (12.90)	351 (10.10)	5,228 (11.76)	7,026

Table 2 Survival associated with preexisting COPD among elderly patients with NSCLC

Group	Total	Dead	Alive censored	Percent	Median
				Alive	(Days)
Stage I NSCLC
Non-COPD	7,184	3,726	3,458	48.13	1,130
COPD	4,835	3,220	1,615	33.4	692
Emphysema	766	473	293	38.25	811
Chronic bronchitis	2,402	1,640	762	31.72	672
Stage II NSCLC
Non-COPD	2,282	1,701	581	25.46	627
COPD	1,123	916	207	18.43	473
Emphysema	171	125	46	26.9	582
Chronic bronchitis	539	446	93	17.25	445
Stage III NSCLC
Non-COPD	10,097	9,029	1,068	10.58	255
COPD	5,315	4,889	426	8.02	224
Emphysema	789	719	70	8.87	229
Chronic bronchitis	2,717	2,522	195	7.18	222
Stage IV NSCLC
Non-COPD	19,675	19,134	541	2.75	112
COPD	8,176	8,003	173	2.12	106
Emphysema	1,398	1,365	33	2.36	110
Chronic bronchitis	4,116	4,041	75	1.82	105

Abbreviation: NSCLC, non-small-cell lung cancer

Table 3 Multivariable analysis of time to death associated with preexisting COPD among elderly patients with NSCLC

Group	HR	LCI	UCI
Overall
COPD	1.11	1.09	1.13
Chronic bronchitis	1.13	1.11	1.16
Emphysema	1.03	1.01	1.07
Stage I NSCLC
COPD	1.39	1.33	1.46
Chronic bronchitis	1.4	1.32	1.49
Emphysema	1.22	1.11	1.35
Stage II NSCLC
COPD	1.2	1.11	1.3
Chronic bronchitis	1.28	1.15	1.43
Emphysema	1.07	1.02	1.28
Stage III NSCLC
COPD	1.09	1.05	1.32
Chronic bronchitis	1.1	1.05	1.15
Emphysema	1.02	1.01	1.08
Stage IV NSCLC
COPD	1.04	1.02	1.07
Chronic bronchitis	1.06	1.02	1.1
Emphysema	1.01	0.91	1.06

Notes: P<0.0001. non-COPD=Reference.

Abbreviations: LCI, lower confidence interval; UCI, upper confidence interval; NSCLC, non-small-cell lung cancer.

Figure 1 Kaplan–Meier survival analysis of COPD versus non-COPD among elderly patients with NSCLC.

Notes: (A) Stage I NSCLC. (B) Stage II NSCLC. (C) Stage III NSCLC. (D) Stage IV NSCLC.

Abbreviations: NSCLC, non-small cell lung cancer.

Figure 2 Kaplan–Meier survival analysis of COPD subtype: chronic bronchitis versus emphysema versus Non-COPD among elderly patients with NSCLC.

Notes: (A) Stage I NSCLC. (B) Stage II NSCLC. (C) Stage III NSCLC. (D) Stage IV NSCLC.

Abbreviations: NSCLC, non-small-cell lung cancer; ChrBronchitis, chronic bronchitis.