Impact of OLD/emphysema in LC mortality risk in screening programs: an analysis of NLST and P-IELCAP

<bold>Introduction:</bold> The impact of obstructive lung disease (OLD) and emphysema on lung cancer (LC) mortality in patients undergoing LC screening is unknown. <bold>Objectives and methods:</bold> Patients with spirometry and LC diagnosed within the first three rounds of screening were selected from the National Lung Screening Trial (NLST) and from the Pamplona International Early Lung Cancer Detection Program (P-IELCAP). Medical and demographic data, tumor characteristics, comorbidities and presence of emphysema were collected. The effect of OLD and emphysema on the risk of overall survival was assessed using unadjusted and adjusted Cox models, competing risk regression analysis, and propensity score matching. <bold>Results:</bold> Data from 353 patients with LC, including 291 with OLD and/or emphysema and 62 with neither, were analyzed. The median age was 67.3 years-old and 56.1% met OLD criteria, predominantly mild (1: 28.3%, 2: 65.2%). Emphysema was present in 69.4% of the patients. Patients with OLD and/or emphysema had worse survival on univariate analysis (HR: 1.40 95%CI: 0.86-2.31, p=0.179). However, after adjusting for LC stage, age, and sex, the HR was 1.02 (95%CI: 0.61-1.70, p=0.952). Specific LC survival between both groups showed an adjusted HR of 0.90 (95%CI: 0.47-1.72, p=0.76). Propensity score matching found no statistically significant difference in overall survival (HR:1.03 95%CI: 0.59-1.9, p=0.929). <bold>Conclusions:</bold> The survival of LC patients diagnosed in the context of screening is not negatively impacted by the coexistence of mild OLD and/or emphysema.