Lung Cancer Risk in US Adults with COPD: A Systematic Review and Meta-Analysis

Peggy-ita Obeng-Nyarkoh,1 Maria E Valentin-Figueroa,1 Christopher J Cadham,2 Nathan K Cobb,3 MeiLan K Han,4 David T Levy,1 Rafael Meza,5 Luz M Sanchez-Romero1 1Department of Oncology, Georgetown University Medical Center, Washington D.C, DC, USA; 2Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA; 3Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Georgetown University Medical Center, Washington D.C, DC, USA; 4Division of Pulmonary and Critical Care Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA; 5Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, CanadaCorrespondence: Luz M Sanchez-Romero, Department of Oncology, Georgetown University Medical Center, 2115 Wisconsin Ave, Suite 300, Washington, DC, 20007, USA, Email [email protected]: Chronic obstructive pulmonary disease (COPD) is an important risk factor for the development of, and death from, lung cancer.Methods: We conducted a systematic review and meta-analysis assessing the risk of lung cancer incidence and mortality among adults with a COPD diagnosis in the United States (US) and exploring differences by subgroups. We searched MEDLINE, Embase, and PubMed from inception to July 2024 for observational studies that investigated the association between COPD and lung cancer incidence and mortality risk. We conducted a meta-analysis for overall risk and COPD assessment methods, and a systematic review for analyses within sex, race/ethnicity, smoking status.Results: Twenty observational studies (n=638,610) were included in the systematic review and meta-analysis. US adults with COPD were found to have higher odds of developing (OR, 1.76; [1.53 to 1.99]) and higher hazards of dying (HR, 1.48; [1.06 to 1.89]) from lung cancer compared to those without COPD. Mixed results were observed when stratifying the impact of COPD on lung cancer risk by subgroups (ie, sex, race and ethnicity and smoking status). Generally, the same trend was observed where people in each subgroup with COPD were at higher risk of lung cancer incidence and mortality compared to those in the same subgroups without the disease. Individuals assessed by self-reported COPD and spirometry showed greater incidence risk but not mortality risk.Conclusion: US adults with COPD, including those with a smoking history, are at an increased risk for lung cancer incidence and mortality compared to those without COPD regardless of sex and race and ethnicity.Keywords: chronic obstructive pulmonary diseases, systematic review, United States, incidence, mortality, smoking