Impact of Chronic Obstructive Pulmonary Disease on the Prognosis of Patients with Lung Cancer

<bold>Background:</bold> Chronic obstructive pulmonary disease (COPD) and lung cancer often coexist. The study was to examine the impact of COPD on prognosis of lung cancer patients. <bold>Methods:</bold> We retrospectively collected lung adenocarcinomas (LUADs) treated with radical surgery and received molecular analysis in West China Hospital between 2016 and 2018. They were classified into two groups: LUAD concomitant with COPD (COPD-LUAD) and non-COPD LUAD patients. The COPD population was composed of patients with a COPD diagnosis before the diagnosis of LUAD. We analyzed the clinicopathological, molecular and prognosis of patients between these two groups. <bold>Results:</bold> A total of 1148 LUAD cases were divided into the COPD-LUAD group (n = 98) and the non-COPD-LUAD group (n = 1050). There were more males (68.0% vs 41.6%, p<0.001) and smokers (56.0% vs 40.2%, p=0.034) in the COPD-LUAD group. The patients in the COPD-LUAD group were older (65 vs 62 years, p=0.03) and had more comorbidities (44.0% vs 29.5%, p=0.038). No significant difference in the TNM stage was observed. The 5-year overall survival (OS) of non-COPD-LUAD patients was better than that of COPD-LUAD ones (54.3% vs 48.0%, p=0.048). Comparing the genetic alterations of the two groups, COPD-LC had lower frequency of EGFR mutation (21.4% vs 44.5%, p<0.001) and targetable genetic alterations (53.1% vs 72.3%, p<0.001). Immunotherapy biomarker of PDL1 positive frequency (38.6% vs 23.4%, p<0.001) were higher in COPD-LUAD group. <bold>Conclusion:</bold> A diagnosis of COPD was associated with poor prognosis in LUAD patients. Although COPD-LC had fewer targetable genetic alterations, higher PD-L1 expression indicated these patients may benefit more from immunotherapy.