Comparison of clinical characteristics and overall survival between spirometrically diagnosed chronic obstructive pulmonary disease (COPD) and non-COPD never-smoking stage I-IV non-small cell lung cancer patients

Figures & data

Table 1 Clinical characteristics of subgroups by non-COPD and COPD among never smoker NSCLC (n=345)

	Non-COPD (n=277) (n,%)	COPD (n=68) (n,%)	p-value
Sex			<0.001
Male	54 (19.5)	30 (44.1)
Female	223 (80.5)	38 (55.9)
Median age (year)	64.2 (30–92)	75.2 (48–89)
Stage			0.783
I	72 (26.1)	15 (22.1)
II	23 (8.3)	5 (7.4)
III	42 (15.2)	9 (13.2)
IV	139 (50.4)	39 (57.4)
T stage T1/T2/T3/T4	68(31.2)/74(33.9)/25(11.5)/51(23.4)	18(36.7)/13(26.5)/4(8.2)/14(28.6)	0.594
N stage N0/N1/N2/N3	91(41.6)/26(11.9)/44(20.1)/58(26.5)	19(38.8)/3(6.1)/11(22.4)/16(32.7)	0.581
M stage M0/M1	135(50.4)/133(49.6)	29(46.0)/34(54.0)	0.535
Median overall survival (months)	29.8 (22.2–37.3)	16.7 (11.2–22.2)	0.002
BMI (kg/m2)	23.5±3.5	22.9±3.5	0.233
EGFR mutation*	129 (49.0)	20 (30.3)	0.006
Number tested (%)	263 (94.9)	66 (97.1)
ALK mutation*	15 (6.2)	3 (4.7)	0.638
Number tested (%)	240 (86.6)	64 (94.1)
1^st line treatment			0.038
Surgery	104 (37.7)	16 (23.9)
Chemotherapy	94 (34.1)	27 (40.3)
Targeted therapy	53 (19.2)	10 (14.9)
Radiotherapy alone	3 (1.1)	2 (3.0)
Supportive care	22 (8.0)	12 (17.9)
Undergone 2^nd line treatment	134 (48.4)	24 (35.3)	0.052
ECOG			0.007
0–1	244 (88.7)	51 (76.1)
≥2	31 (11.3)	16 (23.9)
Pathology			0.302
Squamous	12 (4.3)	5 (7.4)
Non-squamous	265 (95.7)	63 (92.6)
FEV1 (liter)	2.01±0.69	1.59±0.56	<0.001
FEV1 (% predicted)	94.2±23.2	78.4±20.2	<0.001
FVC (liter)	2.53±0.76	2.56±0.85	0.786
FVC (% predicted)	88.8±21.3	90.1±21.5	0.667
FEV1/FVC (% predicted)	78.7±6.9	62.5±8.0	<0.001
DLCO (abs)	14.2±7.1	12.2±5.3	0.032
DLCO (%)	80.0±21.0	74.6±26.6	0.085

Notes: *The number in the brackets indicates a proportion of patients with positive mutation among the tested patients.

Abbreviations: ALK: anaplastic lymphoma kinase; BMI: body mass index; COPD: chronic obstructive pulmonary disease; DLCO: diffusing capacity of the lung for carbon monoxide; ECOG: Eastern Cooperative Oncology Group; EGFR: epidermal growth factor receptor; FEV1; forced expiratory volume in 1 s; FVC: forced vital capacity; OS: overall survival.

Figure 1 Flowchart of the patients enrolled in the study.

Abbreviations: COPD, chronic obstructive pulmonary disease; NSCLC, non-small cell lung cancer; PFT, pulmonary function test.

Table 2 Risk factors for nonsmoker COPD among NSCLC patients (univariate and multivariate analysis)

	Univariate			Multiple
Characteristics	OR	95% CI	P	OR	95% CI	P
Male/Female	3.791	1.856–5.727	<0.001	3.202	1.756–5.839	<0.001
Age (≤65/>65)	2.752	1.541–4.914	0.001	2.255	1.206–4.217	0.011
ECOG (0–1/≥2)	2.469	1.258–4.848	0.009	1.767	0.850–3.671	0.127
EGFR mutation (negative/positive)	0.452	0.253–0.805	0.007	0.516	0.278–0.955	0.035
Histology (nonsquamous/squamous)	1.753	0.596–5.155	0.308	-	-	-
BMI (≥23/<23)	1.332	0.780–2.274	0.294	-	-	-
Stage (I-IIIA/IIIB-IV)	1.573	0.902–2.742	0.110	-	-	-

Abbreviations: BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ECOG, Eastern Cooperative Oncology Group; EGFR, epidermal growth factor receptor; OR, odds ratio.

Table 3 Comparison of clinical characteristics between the non-COPD and COPD groups in never smoker NSCLC after propensity score matching

	Non-COPD (n=155) (n,%)	COPD (n=63) (n,%)	p-value
Sex			0.015
Male	47 (30.3)	30 (47.6)
Female	108 (69.68)	33 (52.4)
Median age (year)	69 (30–92)	75 (48–89)
Stage			0.905
I	33 (21.3)	14 (22.2)
II	15 (9.7)	5 (7.9)
III	27 (17.4)	9 (14.3)
IV	80 (51.6)	35 (55.6)
T stage T1/T2/T3/T4	30(24.6)/42(34.4)/18(14.8)/32(26.2)	15(34.1)/12(27.3)/4(9.1)/13(29.6)	0.475
N stage N0/N1/N2/N3	45(36.9)/18(14.8)/23(18.9)/36(29.5)	17(38.6)/3(6.8)/11(25.0)/13(29.6)	0.526
M stage M0/M1	74(49.3)/76(50.7)	28(48.3)/30(51.7)	0.891
Median overall survival (months)	14.7 (0.4–70.4)	13.7 (0.1–63.9)	0.287
BMI (kg/m2)	23.4±3.6	22.7±3.2	0.197
EGFR mutation	60 (38.7)	19 (30.2)	0.234
ALK mutation	10 (7.3)	3 (4.8)	0.523
1^st line treatment			0.357
Surgery	53 (34.2)	16 (25.4)
Chemotherapy	52 (33.6)	25 (39.7)
Targeted therapy	28 (18.1)	9 (14.3)
Radiotherapy alone	2 (1.3)	2 (3.2)
Supportive care	17 (11.0)	11 (17.5)
Undergone 2^nd line treatment	61 (39.4)	24 (38.1)	0.863
ECOG			0.269
0–1	126 (81.3)	47 (74.6)
≥2	29 (18.7)	16 (25.4)
Pathology			0.561
Squamous	9 (5.8)	5 (7.9)
Non-squamous	146 (94.2)	58 (92.1)
FEV1 (liter)	1.9±0.8	1.6±0.6	0.001
FEV1 (% predicted)	95.8±23.2	77.6±19.6	<0.001
FVC (liter)	2.5±0.9	2.6±0.9	0.405
FVC (% predicted)	88.3±21.5	90.3±22.0	0.534
FEV1/FVC (% predicted)	78.4±5.5	62.3±8.1	<0.001
DLCO (abs)	14.1±9.0	12.3±5.5	0.159
DLCO (%)	80.7±21.7	73.4±26.2	0.042

Abbreviations: ALK: anaplastic lymphoma kinase; BMI: body mass index; COPD: chronic obstructive pulmonary disease; DLCO: diffusing capacity of the lung for carbon monoxide; ECOG: Eastern Cooperative Oncology Group; EGFR: epidermal growth factor receptor; FEV1; forced expiratory volume in 1 s; FVC: forced vital capacity; OS: overall survival.

Figure 2 Comparison of overall survival between the COPD and non-COPD group in the never-smoker non-small cell lung cancer patients after propensity score matching.

Table 4 Variables analyses for mortality in the 218 patients with NSCLC after propensity score matching

	Univariate			Multivariate
Characteristics	P	HR	95% CI	P	HR	95% CI
Age (≤65/>65)	0.218	1.297	0.858–1.961	0.139	1.374	0.902–2.091
Male/Female	0.924	1.020	0.682–1.524	0.857	1.039	0.685–1.575
Histology (nonsquamous/squamous)	0.789	0.910	0.458–1.811
EGFR mutation (positive/negative)	0.114	1.393	0.923–2.102
ECOG (0–1/≥2)	0.220	1.332	0.843–2.104
First line treatment (active/supportive)	0.019	2.183	1.135–4.200	0.014	2.271	1.177–4.380
Stage (I-IIIA/IIIB-IV)	0.033	1.625	1.040–2.540	0.047	1.585	1.006–2.496
COPD (non-COPD/COPD)	0.032	1.545	1.037–2.302	0.044	1.526	1.012–2.300
BMI (≥23/<23)	0.587	1.113	0.756–1.638	-	-	-

Abbreviations: BMI, body mass index; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ECOG, Eastern Cooperative Oncology Group; EGFR, epidermal growth factor receptor; HR, hazard ratio; OS, overall survival.