Pulmonary Function at NSCLC Diagnosis May Impact Overall Survival

New study findings are indicating that having good pulmonary function at the time of diagnosis of non-small cell lung cancer (NSCLC) may improve survival.

Drawing on data from more than 2000 patients in the Boston Lung Cancer Study, the researchers of the retrospective study found that pulmonary function test (PFT) results were associated with overall survival (OS).

In both univariate and multiple regression models, the researchers observed that patients in the highest quartiles (75%-100%) of forced expiratory volume in 1 second (FEV₁), FEV₁%, forced vital capacity (FVC), and FVC% had favorable mortality than patients in the lower quartiles.

“Based on the study finding, we recommend spirometry tests to be regularly conducted for risk stratification of lung cancer patients upon their diagnosis, regardless of their stage, which will further inform clinical decisions for appropriate treatment and care strategies to prolong their long-term survival,” highlighted the researchers.

“And spirometry might be extremely helpful for patients in advanced stages since a more personalized treatment strategy for them could better improve their survival outcomes. As pulmonary function could be an early biomarker for disease and aging, further research could dive into the observed role of pulmonary function in developing biomarkers and treatment targets for lung cancer prognosis," they added.

The researchers also explored how chronic obstructive pulmonary disease (COPD) impacted survival of NSCLC, finding that regardless of the stage, patients with COPD had worse survival. Median survival among patients without COPD was 75.8 months compared with 68.8 months among patients with GOLD stage 1 COPD, 58.6 months among patients with GOLD stage 2 COPD, 38.3 months among patients with GOLD stage 3 COPD, and 29.6 months among patients with GOLD stage 4 COPD.

Patients who had COPD were older, more likely to be male, have a lower body mass index, and more likely to be smokers compared with patients who did not have COPD. These patients also had a higher rate of squamous cell cancer (28% vs 17.65%), a lower rate of adenocarcinoma types (53.73% vs 64.51%), and they were more likely to receive surgery in addition to chemotherapy/radiation (21.17% vs 15.94%) compared with patients without COPD.

The group noted that their study did not include certain prognostic factors, such as performance status and physical activity, which could have introduced bias into their results. They cited other limitations of their study, including a potential of selection bias as patients with advanced stages of disease were less likely to receive PFTs.

“Therefore, we are cautious about the generalizability of the results to a general lung cancer population,” noted the researchers.

“However, we did perform several sensitivity analyses and observed similar dose–response relationships between baseline pulmonary function and overall survival as compared to the main results. Moreover, with our main interest focused on pulmonary function, the current findings were still useful for verifying the important role of the baseline pulmonary function in lung cancer prognosis," they concluded.

Reference

Zhai T, Li Y, Brown R, Lanuti M, Gainor J, Christiani D. Spirometry at diagnosis and overall survival in non-small cell lung cancer patients. Cancer Med. Published online May 12, 2022. doi:10.1002/cam4.4808