Analysis of optimal treatment and prognostic factors in patients with small-cell lung cancer comorbid COPD

Background: and Objective: Patients with small cell lung cancer (SCLC) comorbid COPD are not rare clinically, but related studies are limited, and there is no consensus on optimal treatment and prognostic factors for these patients. In this study, the clinical characteristics and the efficacy of different treatment regimens of patients with SCLC comorbid COPD were analyzed retrospectively to explore the optimal regimens and prognostic factors. Patients and methods: A retrospective study was conducted on 97 patients with SCLC who received first-line etoposide combined with platinum chemotherapy from January 1, 2013 to September 31, 2020 in the first affiliated hospital of Guangzhou Medical University.patients were divided into COPD and non-COPD group, progression-free survival (PFS) and overall survival (OS) were compared between the two groups and prognostic factors of SCLC were analyzed. Furthermore, the differences of PFS and OS and prognostic factors were analyzed in the sub-group of COPD patients (COPD treated group and COPD untreated group). Results: : There were no significant difference in median PFS (7.4 months VS 7.6 months, p = 0.327) and OS (11.2 months VS 14.5 months, p = 0.081) between COPD group (N = 61) and non-COPD group (N = 36). In the COPD group, 21 patients (34.4%) received COPD treatment. And the median OS of COPD treated group was was longer than that of COPD untreated group (13.4 months VS 10.6 months, p = 0.032), but there existed no significant difference in PFS between the two groups (7.4 months VS 7.0 months, p = 0.648). In patients with SCLC comorbid COPD, multivariate regression analysis indicated that COPD was not a risk factor for OS, while extensive stage was independently associated with poorer OS and chest radiotherapy was independently associated with longger OS. Conclusion: For SCLC patients who received first-line cytotoxic chemotherapy, COPD does not impair prognosis, and COPD treatment was benefit for OS of those comorbid COPD, receiving both COPD treatment and chemotherapy was a preferred option as first-line treatment for patients with SCLC comorbid COPD. Extensive stage and thoracic radiotherapy are independent prognostic factors for OS in patients with SCLC comorbid COPD.