Li-Han Hsu, Yi-Hsuan Lin, An-Chen Feng, Nei-Min Chu, Shu-Huei Kao
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引用次数: 0
Abstract
Background: Chronic airway inflammation in asthma and/or chronic obstructive pulmonary disease (COPD) is presumed to be protumorigenic. The tumor inhibitory effect of inhaled corticosteroids (ICSs) used to reduce airway inflammation in patients with asthma and COPD remains unclear.
Objectives: This study aimed to evaluate the impact of coexisting asthma and/or COPD on the survival of patients with lung adenocarcinoma. The effects of ICS treatment were also assessed.
Design: This retrospective, real-world cohort study was conducted at a cancer center.
Methods: The overall survival of a cohort of 1524 consecutive patients with lung adenocarcinoma who were enrolled between January 2011 and December 2019 and followed up until December 2022 was analyzed, followed by subgroup comparisons.
Results: A total of 283 patients had coexisting asthma and/or COPD. Among them, 212 had used ICSs. ICS users were predominantly women, older, and had more advanced-stage disease; moreover, there were fewer tobacco smokers, fewer comorbidities, and relatively severe obstructive impairments than non-ICS users. When restricted to stage 0-II diseases, patients with coexisting asthma and/or COPD had a lower 5-year overall survival rate (77% vs 90%, p < 0.001), with a hazard ratio of 1.8, in contrast to no difference among patients with stage III-IV disease. ICS users had a lower 5-year overall survival rate in both subgroups, although the difference was not statistically significant.
Conclusion: The impact of cancer on prognosis may overwhelm the effects of asthma and/or COPD in patients with advanced-stage lung adenocarcinoma. The evaluation of the effects of ICS treatment appears to be confounded by intent and compliance, which can introduce bias in the opposite direction. However, investigating the treatment effects on asthma and/or COPD control would be beneficial. A systematic prospective study is required to define the role of the ICS.
背景：哮喘和/或慢性阻塞性肺疾病（COPD）的慢性气道炎症被认为是致瘤性的。用于减轻哮喘和COPD患者气道炎症的吸入性皮质类固醇（ICSs）的肿瘤抑制作用尚不清楚。目的：本研究旨在评估并发哮喘和/或COPD对肺腺癌患者生存的影响。还评估了ICS治疗的效果。设计：这项回顾性的、真实世界的队列研究是在一个癌症中心进行的。方法：对2011年1月至2019年12月期间入组并随访至2022年12月的1524例连续肺腺癌患者的总生存率进行分析，然后进行亚组比较。结果：共有283例患者同时患有哮喘和/或COPD。其中212人使用了国际系统。ICS使用者主要是女性，年龄较大，并且有更多的晚期疾病；此外，与非ics使用者相比，吸烟者较少，合并症较少，阻塞性损伤相对严重。当局限于0-II期疾病时，合并哮喘和/或COPD患者的5年总生存率较低（77% vs 90%）。结论：癌症对预后的影响可能超过哮喘和/或COPD对晚期肺腺癌患者的影响。ICS治疗效果的评估似乎被意图和依从性所混淆，这可能导致相反方向的偏倚。然而，研究对哮喘和/或COPD控制的治疗效果将是有益的。需要进行系统的前瞻性研究来确定ICS的作用。
期刊介绍：
Therapeutic Advances in Medical Oncology is an open access, peer-reviewed journal delivering the highest quality articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of cancer. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in medical oncology, providing a forum in print and online for publishing the highest quality articles in this area. This journal is a member of the Committee on Publication Ethics (COPE).
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