Brief Report: Emphysema as a prognostic factor in advanced NSCLC patients with COPD receiving immune checkpoint inhibitors.

Abstract

Background: Chronic obstructive pulmonary disease (COPD) and emphysema are independent risk factors for lung cancer development and have been independently associated with longer overall survival (OS) in non-small-cell lung cancer (NSCLC) patients treated with immune checkpoint inhibitors (ICIs). However, their combined impact on prognosis remains unclear. This study evaluates emphysema as a prognostic factor in COPD patients with advanced NSCLC (aNSCLC) undergoing immunotherapy.

Methods: This study included aNSCLC patients with COPD (defined by spirometry), treated with single-agent ICI as first or second-line treatment, from 2013 to 2024. Patients were classified based on visually detected emphysema on chest computed tomography (cCT).

Results: The study included 111 patients with COPD, of whom 77 had coexisting emphysema. Patients with COPD and emphysema had significantly longer OS compared to those without emphysema (17.3 vs. 8.5 months, p = 0.008), with a non-significant trend toward improved PFS (3.3 vs. 2.4 months, p = 0.641). Emphysema remained an independent factor of better OS in multivariate analysis (HR: 0.49; 95% CI: 0.30-0.81). Adverse event rates were similar regardless of emphysema status (p = 0.455).

Conclusions: This study suggests that visually detected emphysema on cCT, could be a potential prognostic marker in aNSCLC patients with COPD receiving ICIs. Further studies are guaranteed to confirm these findings.