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Background <p>Chronic obstructive pulmonary disease (COPD) frequently coexists with non–small cell lung cancer (NSCLC). Previous studies suggest that COPD may be associated with improved outcomes in patients receiving immune checkpoint inhibitor (ICI) monotherapy, but its impact in patients treated with ICI plus chemotherapy remains unclear.</p> Methods <p>In this retrospective single-institution study, we evaluated 55 ever-smokers with stage IV NSCLC treated with first-line ICI plus chemotherapy who underwent pulmonary function testing. COPD was defined as a post-bronchodilator FEV<sub>1</sub>/FVC ratio &lt; 0.70, and patients were classified into COPD (<i>n</i> = 33) and non-COPD (<i>n</i> = 22) groups. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier methods and Cox proportional hazards models. To reduce baseline confounding, inverse probability of treatment weighting (IPTW) based on propensity scores was applied.</p> Results <p>In unadjusted analyses, median PFS was 5.3&#xa0;months in the COPD group and 11.1&#xa0;months in the non-COPD group (hazard ratio [HR] 1.79, 95% confidence interval [CI] 0.95–3.37; <i>p</i> = 0.071). After IPTW adjustment, PFS was significantly shorter in the COPD group (median 4.6&#xa0;months vs 13.7&#xa0;months; HR 2.54, 95% CI 1.29–5.00; <i>p</i> = 0.007). In unadjusted analyses, median OS was 12.7&#xa0;months in the COPD group and not reached in the non-COPD group (HR 1.56, 95% CI 0.73–3.33; <i>p</i> = 0.247). After IPTW adjustment, OS was significantly shorter in the COPD group (median 11.8&#xa0;months vs not reached; HR 3.00, 95% CI 1.16–7.73; <i>p</i> = 0.023).</p> Conclusions <p>COPD may be associated with poorer survival among ever-smokers with advanced NSCLC receiving first-line ICI plus chemotherapy, although further validation in larger cohorts is warranted.</p>

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COPD is associated with poorer survival in patients with advanced non-small cell lung cancer treated with first-line ICI plus chemotherapy

  • 期刊论文

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  • 发表日期：

    2026年7月20日

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  • Akihisa Takano,
  • Daisuke Shibahara,
  • Hiroaki Ogata,
  • Sai Yasukochi,
  • Ryosuke Matsukane,
  • Toshifumi Ninomiya,
  • Takahiro Utsumi,
  • Yuki Ikematsu,
  • Kohei Otsubo,
  • Yoshimasa Shiraishi,
  • Eiji Iwama,
  • Mayako Uchida,
  • Isamu Okamoto

摘要

Background

Chronic obstructive pulmonary disease (COPD) frequently coexists with non–small cell lung cancer (NSCLC). Previous studies suggest that COPD may be associated with improved outcomes in patients receiving immune checkpoint inhibitor (ICI) monotherapy, but its impact in patients treated with ICI plus chemotherapy remains unclear.

Methods

In this retrospective single-institution study, we evaluated 55 ever-smokers with stage IV NSCLC treated with first-line ICI plus chemotherapy who underwent pulmonary function testing. COPD was defined as a post-bronchodilator FEV1/FVC ratio < 0.70, and patients were classified into COPD (n = 33) and non-COPD (n = 22) groups. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan–Meier methods and Cox proportional hazards models. To reduce baseline confounding, inverse probability of treatment weighting (IPTW) based on propensity scores was applied.

Results

In unadjusted analyses, median PFS was 5.3 months in the COPD group and 11.1 months in the non-COPD group (hazard ratio [HR] 1.79, 95% confidence interval [CI] 0.95–3.37; p = 0.071). After IPTW adjustment, PFS was significantly shorter in the COPD group (median 4.6 months vs 13.7 months; HR 2.54, 95% CI 1.29–5.00; p = 0.007). In unadjusted analyses, median OS was 12.7 months in the COPD group and not reached in the non-COPD group (HR 1.56, 95% CI 0.73–3.33; p = 0.247). After IPTW adjustment, OS was significantly shorter in the COPD group (median 11.8 months vs not reached; HR 3.00, 95% CI 1.16–7.73; p = 0.023).

Conclusions

COPD may be associated with poorer survival among ever-smokers with advanced NSCLC receiving first-line ICI plus chemotherapy, although further validation in larger cohorts is warranted.