Impact of Chronic Obstruction Pulmonary Disease with Acute Exacerbation on Survival in Current-Smoking Patients with Advanced stages Lung Squamous Cell Carcinoma undergoing Concurrent Chemoradiotherapy

Abstract BACKGROUNDTo date, no data are available regarding the effect of chronic obstruction pulmonary disease (COPD) and COPD with acute exacerbation (COPDAE) on survival in patients with lung squamous cell carcinoma (SCC) receiving definitive concurrent chemoradiotherapy (CCRT).PATIENTS AND METHODSCurrent-smoking patients with clinical stage IIIA-IIIB, lung SCC who had received standard definitive CCRT and categorized them into two groups based on their COPD status to compare overall survival outcomes. We also examined the effects of COPD severity (0, 1, or ≥2 hospitalizations for COPDA within 1 year before CCRT). The aHRs (95% CIs) of lung cancer death for 1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT were 1.21 (1.09, 1.39) and 1.63 (1.34, 1.97), respectively, compared with no hospitalization for COPDAE.RESULTSIn the inverse probability of treatment weighting (IPTW)-adjusted model, the adjusted hazard ratio (aHR) (95% confidence interval [CI]) of all-cause death for COPD was 1.06 (1.07, 1.71) compared with the non-COPD group. Moreover, in the IPTW-adjusted model, the aHRs (95% CIs) of 1 and ≥2 hospitalizations for COPDAE within 1 year before CCRT were 1.29 (1.16, 1.43) and 1.77 (1.41, 2.13), respectively, compared with no hospitalization for COPDAE.CONCLUSIONCOPD and its severity are significant independent risk factors for all-cause death in patients with stage IIIA-IIIB lung SCC receiving definitive CCRT. Hospitalization for COPDAE within 1 year before CCRT is the significant independent risk factors for lung cancer death in the patients with stages IIIA-IIIB lung SCC receiving definitive CCRT.