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Respiratory and cardiometabolic comorbidities and Stage I-III non-small cell lung cancer (NSCLC) survival: A pooled analysis from the International Lung Cancer Consortium (ILCCO)

Published:November 14, 2022DOI:https://doi.org/10.1016/j.jtho.2022.10.020
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      Abstract

      Introduction

      We explored the association of respiratory and cardiometabolic comorbidities with NSCLC overall survival (OS) and lung cancer specific survival (LCSS), by stage, in a large, multi-continent NSCLC pooled dataset.

      Methods

      Based on patients pooled from 11 ILCCO studies with available respiratory and cardiometabolic comorbidity data, adjusted Hazard Ratios (aHR) were estimated using Cox models for OS. LCSS was evaluated using competing risk Grey and Fine models and cumulative incidence functions. Logistic regression (adjusted odds ratio, aOR) was applied to assess factors associated with surgical resection.

      Results

      OS analyses utilized NSCLC patients with respiratory health or cardiometabolic health data (N=16,354); a subset (N=11,614) contributed to LCSS analyses. In stage I-IIIA NSCLC, patients with respiratory comorbidities had worse LCCS (Stage IA aHR 1.51, CI 1.17-1.95; Stage IB-IIIA aHR 1.20, CI 1.06-1.036). In contrast, stage I-IIIA patients with cardiometabolic comorbidities had a higher risk of death from competing (non-NSCLC) causes (Stage IA aHR 1.34, CI 1.12-1.69). The presence of respiratory comorbidities was inversely associated with having surgical resection (Stage IA aOR 0.54 CI 0.35-0.83; Stage IB-IIIA aOR 0.57, CI 0.46-0.70).

      Conclusion

      The presence of either cardiometabolic or respiratory comorbidities is associated with worse OS in Stage I-III NSCLC. Patients with respiratory comorbidities were less likely to undergo surgery and had worse LCSS, while patients with cardiometabolic comorbidities had a higher risk of death from competing causes. As more treatments options for Stage I-III NSCLC are introduced into practice, accounting for cardiometabolic and respiratory comorbidities becomes essential in trial interpretation and clinical management.

      Keywords

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