Association of chronic obstructive pulmonary disease and tumor recurrence in patients with stage IA lung cancer after complete resection

Abstract

Background: Chronic obstructive pulmonary disease (COPD) poses a high risk for postoperative pulmonary complications after lung cancer surgery. We sought to determine the impact of this disease on long-term survival after surgical resection and to identify prognostic factors in pathological stage IA lung cancer.

Methods: A retrospective chart review was completed in 442 patients with pathological stage IA lung cancer, who had a lobectomy with systematic lymph node dissection (30.3%), out of 1,461 patients who underwent lung cancer surgery at our hospital from January 1990 to April 2005. The functional definition of COPD, according to the spirometric guidelines of the Global Initiative for Chronic Obstructive Lung Disease, was forced expiratory volume in 1 second to forced vital capacity less than 70% (FEV1/FVC). The postoperative complications were compared between the non-COPD (362 patients) and COPD (80 patients) groups. Overall survival and disease-free survival were analyzed using the Kaplan-Meier method and log-rank test. Prognostic factors were identified by univariate and multivariate analyses.

Results: The frequencies of all pulmonary complications except for pneumonia and tracheostomy were similar between the two groups. Overall survival and disease-free survival in the COPD group were significantly worse than those in the non-COPD group (p < 0.0001 and p = 0.037, respectively). Significant prognostic factors were larger tumor size (p = 0.0035) and COPD (p = 0.0147). Significant risk factors for cancer recurrence were larger tumor size (p = 0.001) and COPD (p = 0.0105) by multivariate analyses.

Conclusions: Patients with COPD had poorer long-term survival. This may be due to a higher incidence of tumor recurrence.