Prevalence of lung cancer in chronic obstructive pulmonary disease: A systematic review and meta-analysis

The Impact of Chronic Obstructive Pulmonary Disease on Immune Checkpoint Inhibitor Effectiveness in Non-small Cell Lung Cancer: A Population Health Study

SUMMARY

Chronic obstructive pulmonary disease (COPD) and lung cancer are associated diseases. COPD confers a negative prognosis in NSCLC, but the clinical benefit of immune checkpoint inhibitors (ICI) in this population is unclear. A population-level analysis of patients in Ontario, Canada was performed through the ICES (formerly known as the Institute for Clinical Evaluative Sciences) administrative database. Patients with NSCLC and treated with PD-1/PD-L1 immune checkpoint inhibitors between Jan 2010 and Dec 2020 were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using Cox proportional hazards regression. Hospitalizations and duration of treatment were compared secondarily using logistic and linear regression. A total of 4306 patients received ICI and 54% of patients had a diagnosis of COPD. Median (95% CI) OS was 9.2 (8.5-9.9) months for patients with COPD and 8.2 (7.3-8.8) for patients without COPD, which was not significantly different (adjusted hazard ratio (aHR) = 0.94, 95% CI, 0.87-1.01, P = 0.092). Similarly, the median time on treatment was not different (85 vs. 99 days, multivariable P = 0.10). However, the 90-day hospitalization rate was decreased in the COPD population (multivariable odds ratio 0.76, 95% CI 0.62-0.94, P = 0.011). Among patients with NSCLC receiving ICI, our data suggest that a diagnosis of COPD does not result in shortened treatment, poorer survival, or higher rates of hospitalization. COPD itself should not be considered a contraindication to ICI.

Identifying pyroptosis-related prognostic genes in the co-occurrence of lung adenocarcinoma and COPD via bioinformatics analysis

Studies have indicated a complex association between chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma (LUAD). However, the underlying mechanisms of their coexistence are still not fully understood. Thus, this study evaluated the possible mechanisms and biomarkers of COPD and LUAD by analyzing public RNA sequencing databases via bioinformatics analysis. This study obtained the LUAD datasets (TCGA-LUAD, GSE118370, and GSE30219) and the COPD dataset (GSE11784 and GSE39874) from TCGA and GEO databases, respectively. The differentially expressed genes (DEGs) were analyzed using the DESeq2 and limma packages. These DEGs were then intersected with pyroptosis-related genes (PRGs) to produce PRDEGs, which were examined via GO analysis and KEGG enrichment analyses. Simultaneously, a prognostic model was developed using PRDEGs by the TCGA-LUAD dataset to generate diagnostic PRDEGs (DPRDEGs). The STING database was employed to develop a protein-protein interaction (PPI) network for DPRDEGs. Transcription factors-associated with DPRDEGs were also identified in the ChIPBase and hTFtarget databases. The comparative toxicogenomics database (CTD) was employed to detect possible drugs or small molecules that interacted with DPRDEGs, and results were illustrated using Cytoscape. Moreover, this study developed a prognostic model using multivariate analysis and simultaneously conducted a prognostic analysis. The results were further validated by immunohistochemistry (IHC), western blotting (WB), and qPCR of clinical specimens. A total of 273 DEGs were identified, and 12 PRDEGs were detected after intersecting with PRGs. Inflammation and infectious diseases were the primary enriched regions for these PRDEGs, as indicated by GO and KEGG enrichment analyses. The study identified six DPRDEGs (BNIP3, FTO, NEK7, POLR2H, S100A12, and TLR4) via prognosis modeling of PRDEGs. The expression of these DPRDEGs in COPD and LUAD was verified through IHC, WB, and qPCR examinations. Based on multifactorial prognosis modeling, among six, FTO, POLR2H, S100A12, and TLR4 revealed enhanced prognostic predictive effects. This study demonstrated that COPD and LUAD have common pathogenic mechanisms. The identified DPRDEGs and predictive models offer new perspectives for understanding and addressing COPD and LUAD.

The interactions among factors associated with the risk of lung cancer among diabetes patients: a survival tree analysis

Past epidemiological studies demonstrated mixed findings on the association between diabetes and lung cancer. Given the possible links between diabetes, smoking, and respiratory diseases, this study aims to examine the interaction patterns among factors associated with the risk of lung cancer among diabetes patients. A territory-wide retrospective cohort study was performed using electronic health records of Hong Kong. Patients who received diabetes care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019. Conditional inference survival tree was applied to examine the interaction patterns among factors associated with the risk of lung cancer. A total of 385,521 patients were included. During a median follow-up of 6.2 years, 3395 developed lung cancer. Age emerged as primary factor in differentiating the risk of lung cancer. Conditional on age ( ≤ 64 vs >64 years), smoking appeared as subsequent dominant risk factor within each subpopulation. Among old smokers aged >64 years characterized by long duration of diabetes (median: 6-8 years), chronic obstructive pulmonary disease (COPD) emerged as key risk factor. Six distinct subgroups of diabetes patients with different risk levels of lung cancer according to age, smoking, metformin use, and COPD status were identified. Findings of the study suggest the interaction patterns among age, smoking, and COPD on the risk of lung cancer among diabetes patients, providing targets for public health interventions.

COPD and cardiovascular risk

Chronic Obstructive Pulmonary Disease (COPD) usually presents joined to other pathologies we call comorbidities. The more frequent of them are those related to cardiovascular risk, either its risk factors or its clinical manifestations. Cardiovascular risk of these patients grows up with the severity of the airflow obstruction, specially during and after an exacerbation of COPD. Patients with COPD have between 2 and 5 times more risk of ischaemic heart disease than people without COPD, even after adjusting for cofounding factors. Cardiovascular diseases are up to the second cause of mortality in these patients, close to those due to the lung disease. Although COPD is associated to several cardiovascular risk factors such as tobacco, arterial hypertension or Diabetes Mellitus, they don't explain all the excess in cardiovascular risk these patients have. Despite that excess of cardiovascular risk in COPD patients, most widely used cardiovascular risk scores don't include COPD as a risk factor itself, so global risk is understimated in these patients. In this review, we make a bibliography revision of the avaliable evidence about COPD and cardiovascular risk factors as well as the excess of cardiovascular risk COPD itself involves.

Proteomic Analysis of Plasma Exosomes Enables the Identification of Lung Cancer in Patients With Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is confirmed as an independent risk factor for the development of lung cancer. Although low-dose CT screening significantly reduces the mortality rate of lung cancer, the misdiagnosis and missed diagnosis rates remain high in the COPD population. Additionally, several COPD patients are unable to undergo invasive histological examinations. Therefore, there is an urgent need for minimally invasive biomarkers to screen or diagnose lung cancer in COPD patients. In this study, peripheral blood samples were collected from COPD patients with and without lung cancer. Plasma exosomes (EVs) were extracted for proteomic analysis. Sixteen differentially expressed proteins (DEPs) were preliminarily selected via label-free quantification (LFQ) proteomic technology and comprehensive bioinformatics analysis. Parallel reaction monitoring (PRM) targeted validation identified five candidate proteins associated with COPD with lung cancer. Compared to the COPD group, KRT1, KRT9, and KRT10 were significantly upregulated in the COPD with lung cancer group, while GPLD1 and TF were downregulated. The biomarkers identified in our study provide a foundation for non-invasive screening and diagnosis of lung cancer in COPD patients and exploration of the mechanisms shared between COPD and lung cancer.

Defining precancer: a grand challenge for the cancer community

The term 'precancer' typically refers to an early stage of neoplastic development that is distinguishable from normal tissue owing to molecular and phenotypic alterations, resulting in abnormal cells that are at least partially self-sustaining and function outside of normal cellular cues that constrain cell proliferation and survival. Although such cells are often histologically distinct from both the corresponding normal and invasive cancer cells of the same tissue origin, defining precancer remains a challenge for both the research and clinical communities. Once sufficient molecular and phenotypic changes have occurred in the precancer, the tissue is identified as a 'cancer' by a histopathologist. While even diagnosing cancer can at times be challenging, the determination of invasive cancer is generally less ambiguous and suggests a high likelihood of and potential for metastatic disease. The 'hallmarks of cancer' set out the fundamental organizing principles of malignant transformation but exactly how many of these hallmarks and in what configuration they define precancer has not been clearly and consistently determined. In this Expert Recommendation, we provide a starting point for a conceptual framework for defining precancer, which is based on molecular, pathological, clinical and epidemiological criteria, with the goal of advancing our understanding of the initial changes that occur and opportunities to intervene at the earliest possible time point.

Efficacy and safety of radial probe endobronchial ultrasound-guided biopsy for peripheral lung lesions in chronic obstructive pulmonary disease patients

Background

Chronic obstructive pulmonary disease (COPD) is associated with frequent complications after transthoracic biopsy. Radial probe endobronchial ultrasound-guided transbronchial lung biopsy (RP-EBUS-TBLB) is widely used to diagnose peripheral pulmonary lesions (PPLs). However, the efficacy and safety of this procedure for the diagnosis of PPLs in patients with COPD remain poorly understood. We investigated the usefulness of RP-EBUS-TBLB for diagnosing PPLs in patients with COPD.

Methods

This retrospective observational study aimed to identify clinical outcomes of RP-EBUS-TBLB in patients with COPD. A total of 175 patients with COPD and 439 patients without COPD were included in this study. RP-EBUS-TBLB was performed without fluoroscopy using a guide sheath.

Results

The overall diagnostic accuracies in patients with COPD and without COPD were 80.6% (141/175) and 78.8% (346/439), respectively. There was no significant difference in the diagnostic yield based on the severity of airflow limitation (80.0%, 81.4%, and 79.2% for mild, moderate, and severe to very airflow limitations, respectively; P=0.97). In patients with COPD, diagnostic yields for malignant and benign lesions were 85.6% (95/111) and 71.9% (46/64). In multivariable analyses, larger lesion size [≥30 mm; odds ratio (OR), 2.86; 95% confidence interval (CI): 1.10-7.45; P=0.03] and within the lesion on EBUS image (OR 9.29; 95% CI: 3.79-22.79; P<0.001) were associated with diagnostic success in patients with COPD, whereas lesion location of upper lobe (OR, 0.36; 95% CI: 0.14-0.92; P=0.03) were associated with diagnostic failure. The overall complication rate in our study was 7.4% (13/175) in patients with COPD. Pneumothorax occurred in 4.6% (8/175), and chest tube insertion was needed in 1.7% (3/175) of the patients.

Conclusions

RP-EBUS-TBLB can be used as an appropriate method to diagnose PPLs in patients with COPD. The size of the lesion (≥30 mm) and having the probe within the lesion were important for successful diagnosis. The location of the lesion in the upper lobe is associated with diagnostic failure. No difference was observed in the diagnostic yield based on the severity of airflow limitation. The complication rates were acceptable.

The incidence of acute exacerbation of idiopathic pulmonary fibrosis: a systematic review and meta-analysis

Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease with a high incidence of acute exacerbation and an increasing mortality rate. Currently, treatment methods and effects are limited. Therefore, we conducted a meta-analysis of the incidence of acute exacerbation in patients with IPF, hoping to provide reference for the prevention and management of IPF. We systematically searched the PubMed, Embase, Cochrane Library and Web of Science databases. From the creation of the database to the cohort study on April 3, 2023, we collected studies on the incidence of acute exacerbation of IPF patients, and used Stata software (version 16.0) for meta analysis. We used the Newcastle Ottawa Quality Assessment Scale (NOS) to assess the risk of bias for each study. We calculated the incidence of acute exacerbation in IPF patients and analyzed the risk factors for acute exacerbation in IPF patients and prognostic factors for overall survival from the initial IPF diagnosis. A total of ten cohort studies on the incidence of AE-IPF were included, including 11,855 IPF patients. The results showed that the incidence of acute exacerbation within one year was 9%; the incidence of acute exacerbation within 2 years is 13%; the incidence of acute exacerbation within 3 years is 19%; the incidence of acute exacerbation within 4 years is 11%. In addition, one study reported an acute exacerbation rate of 1.9% within 30 days. The incidence of acute exacerbation within ten years reported in one study was 9.8%. Mura et al.'s article included a retrospective cohort study and a prospective cohort study. The prospective cohort study showed that the incidence of acute exacerbation within 3 years was 18.6%, similar to the results of the retrospective cohort study meta-analysis. Our system evaluation and meta-analysis results show that the incidence of AE-IPF is relatively high. Therefore, sufficient attention should be paid to the research results, including the management and prevention of the disease, in order to reduce the risk of AE.Trial registration: PROSPERO, identifier CRD42022341323.

Different DLCO Parameters as Predictors of Postoperative Pulmonary Complications in Mild Chronic Obstructive Pulmonary Disease Patients with Lung Cancer

Background

Numerous studies have investigated methods of predicting postoperative pulmonary complications (PPCs) in lung cancer surgery, with chronic obstructive pulmonary disease (COPD) and low forced expiratory volume in 1 second (FEV1) being recognized as risk factors. However, predicting complications in COPD patients with preserved FEV1 poses challenges. This study considered various diffusing capacity of the lung for carbon monoxide (DLCO) parameters as predictors of pulmonary complication risks in mild COPD patients undergoing lung resection.

Methods

From January 2011 to December 2019, 2,798 patients undergoing segmentectomy or lobectomy for non-small cell lung cancer (NSCLC) were evaluated. Focusing on 709 mild COPD patients, excluding no COPD and moderate/severe cases, 3 models incorporating DLCO, predicted postoperative DLCO (ppoDLCO), and DLCO divided by the alveolar volume (DLCO/VA) were created for logistic regression. The Akaike information criterion and Bayes information criterion were analyzed to assess model fit, with lower values considered more consistent with actual data.

Results

Significantly higher proportions of men, current smokers, and patients who underwent an open approach were observed in the PPC group. In multivariable regression, male sex, an open approach, DLCO <80%, ppoDLCO <60%, and DLCO/VA <80% significantly influenced PPC occurrence. The model using DLCO/VA had the best fit.

Conclusion

Different DLCO parameters can predict PPCs in mild COPD patients after lung resection for NSCLC. The assessment of these factors using a multivariable logistic regression model suggested DLCO/VA as the most valuable predictor.

The impact of chronic obstructive pulmonary disease on the risk of immune-related pneumonitis in lung cancer patients undergoing immunotherapy: a systematic review and meta-analysis

BACKGROUND

Lung cancer, a leading cause of cancer mortality, poses significant treatment challenges. The use of immune checkpoint inhibitors (ICIs) has revolutionized therapy, but it is associated with immune-related pneumonitis (IRP). This study systematically reviews and analyzes the impact of Chronic Obstructive Pulmonary Disease (COPD) on the risk of IRP in lung cancer patients undergoing immunotherapy.

METHODS

Adhering to PRISMA guidelines and using the PICO framework, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted. Inclusion criteria encompassed peer-reviewed studies involving lung cancer patients treated with ICIs, comparing those with and without COPD. The primary outcome was the incidence and risk of IRP. The Newcastle-Ottawa Scale evaluated study quality. The effect size was calculated using random or fixed-effects models based on the observed heterogeneity. We assessed the heterogeneity between studies and conducted a sensitivity analysis.

RESULTS

The search identified 1026 articles, with six meeting the criteria for inclusion. Studies varied in design and geography, predominantly retrospective cohort studies. Patients with COPD had an increased risk of IRP (OR = 1.54, 95% CI [1.24, 1.92, P < 0.01). Subgroup analysis based on radiation therapy exposure (< 40% and ≥ 40%) also indicated a heightened IRP risk in COPD patients. Sensitivity analysis affirmed the robustness of the results, and publication bias was not significant.

CONCLUSIONS

Lung cancer patients with COPD undergoing immunotherapy have a significantly increased risk of developing IRP. This highlights the necessity for vigilant monitoring and individualized treatment strategies to improve the safety and effectiveness of immunotherapy in this group.

Lung cancer among outpatients with COPD: a 7-year cohort study

Introduction

Lung cancer (LC) is the most common cause of cancer-related deaths worldwide, and its prognosis upon metastasis remains poor. Patients with COPD face a significantly elevated LC risk, up to six times greater than those with normal lung function. We aimed to investigate LC prevalence and stage distribution among COPD outpatients. Furthermore, we aimed to outline the COPD-related variables associated with referral for LC examination.

Methods

We conducted a retrospective analysis encompassing the period from 1 January 2012 to 31 December 2018 on all outpatients with COPD and LC and individuals referred for LC examinations.

Results

Among all COPD outpatients, 2231 patients (18%) were referred for LC examinations and 565 (4.6%) were diagnosed with LC. LC patients with COPD were more likely to be stage I-II, in contrast to the non-COPD LC population (46% versus 26%, p<0.001 for all). Patients referred for LC examinations exhibited higher use of COPD-related medications, reported more severe dyspnoea (69% versus 66% with Medical Research Council dyspnoea score >2) and experienced a greater frequency of exacerbations (30% versus 24% with two or more exacerbations).

Conclusion

Our study revealed a notably high LC incidence among COPD outpatients. LC patients with COPD were diagnosed at earlier stages, and outpatients with more pronounced COPD symptoms were more inclined to undergo LC diagnostics. The overrepresentation of LC cases among COPD outpatients emphasises the importance of tailoring specific screening initiatives for this demographic.

Complications and comorbidities associated with antineoplastic chemotherapy: Rethinking drug design and delivery for anticancer therapy

Despite the considerable advancements in chemotherapy as a cornerstone modality in cancer treatment, the prevalence of complications and pre-existing diseases is on the rise among cancer patients along with prolonged survival and aging population. The relationships between these disorders and cancer are intricate, bearing significant influence on the survival and quality of life of individuals with cancer and presenting challenges for the prognosis and outcomes of malignancies. Herein, we review the prevailing complications and comorbidities that often accompany chemotherapy and summarize the lessons to learn from inadequate research and management of this scenario, with an emphasis on possible strategies for reducing potential complications and alleviating comorbidities, as well as an overview of current preclinical cancer models and practical advice for establishing bio-faithful preclinical models in such complex context.

Single-cell immunophenotyping revealed the association of CD4+ central and CD4+ effector memory T cells linking exacerbating chronic obstructive pulmonary disease and NSCLC

Introduction

Tobacco smoking generates airway inflammation in chronic obstructive pulmonary disease (COPD), and its involvement in the development of lung cancer is still among the leading causes of early death. Therefore, we aimed to have a better understanding of the disbalance in immunoregulation in chronic inflammatory conditions in smoker subjects with stable COPD (stCOPD), exacerbating COPD (exCOPD), or non-small cell lung cancer (NSCLC).

Methods

Smoker controls without chronic illness were recruited as controls. Through extensive mapping of single cells, surface receptor quantification was achieved by single-cell mass cytometry (CyTOF) with 29 antibodies. The CyTOF characterized 14 main immune subsets such as CD4+, CD8+, CD4+/CD8+, CD4-/CD8-, and γ/δ T cells and other subsets such as CD4+ or CD8+ NKT cells, NK cells, B cells, plasmablasts, monocytes, CD11cdim, mDCs, and pDCs. The CD4+ central memory (CM) T cells (CD4+/CD45RA-/CD45RO+/CD197+) and CD4+ effector memory (EM) T cells (CD4+/CD45RA-/CD45RO+/CD197-) were FACS-sorted for RNA-Seq analysis. Plasma samples were assayed by Luminex MAGPIX® for the quantitative measurement of 17 soluble immuno-oncology mediators (BTLA, CD28, CD80, CD27, CD40, CD86, CTLA-4, GITR, GITRL, HVEM, ICOS, LAG-3, PD-1, PD-L1, PD-L2, TIM-3, TLR-2) in the four studied groups.

Results

Our focus was on T-cell-dependent differences in COPD and NSCLC, where peripheral CD4+ central memory and CD4+ effector memory cells showed a significant reduction in exCOPD and CD4+ CM showed elevation in NSCLC. The transcriptome analysis delineated a perfect correlation of differentially expressed genes between exacerbating COPD and NSCLC-derived peripheral CD4+ CM or CD4+ EM cells. The measurement of 17 immuno-oncology soluble mediators revealed a disease-associated phenotype in the peripheral blood of stCOPD, exCOPD, and NSCLC patients.

Discussion

The applied single-cell mass cytometry, the whole transcriptome profiling of peripheral CD4+ memory cells, and the quantification of 17 plasma mediators provided complex data that may contribute to the understanding of the disbalance in immune homeostasis generated or sustained by tobacco smoking in COPD and NSCLC.

The Lung Microbiome in COPD and Lung Cancer: Exploring the Potential of Metal-Based Drugs

Chronic obstructive pulmonary disease (COPD) and lung cancer 17 are two of the most prevalent and debilitating respiratory diseases worldwide, both associated with high morbidity and mortality rates. As major global health concerns, they impose a substantial burden on patients, healthcare systems, and society at large. Despite their distinct aetiologies, lung cancer and COPD share common risk factors, clinical features, and pathological pathways, which have spurred increasing research interest in their co-occurrence. One area of particular interest is the role of the lung microbiome in the development and progression of these diseases, including the transition from COPD to lung cancer. Exploring novel therapeutic strategies, such as metal-based drugs, offers a potential avenue for targeting the microbiome in these diseases to improve patient outcomes. This review aims to provide an overview of the current understanding of the lung microbiome, with a particular emphasis on COPD and lung cancer, and to discuss the potential of metal-based drugs as a therapeutic strategy for these conditions, specifically concerning targeting the microbiome.

The study of trends in mortality of respiratory system cancers in Babol, North of Iran (2013-2021)

Background

In Iran, cancers are known as the second leading cause of death, among which respiratory system cancers are particularly important because lung cancer is the second most common cause of death in this country. This study aimed to estimate the crude and age-standardized mortality and its trends during 9 years in the Northern city of Iran, Babol.

Methods

In this cross-sectional study, all the recorded deaths due to respiratory system cancers in Babol during the years 2013-2021 on the Classification of Causes of Deaths and Death Registration System of Babol University of Medical Sciences were taken into consideration, and the population estimate was based on the latest census. Finally, the crude and age-standardized rates of mortality and trends of cancer incidents were calculated.

Results

In general, 393 deaths with an overall mean age of 67.8±3.9 years have happened due to respiratory system cancers. The crude and standardized rates of respiratory system cancers increased from 6.5 and 5.5 per hundred thousand people in 2013 to 9.1 and 7.8 per hundred thousand people in 2021, respectively. With each decade in age, their trends increased significantly in men (p=0.024) and remained constant in women (p=0.262). In examining the trend of respiratory system cancers, we found an increasing trend for lung cancer and a constant trend for larynx and oropharynx cancers. There was also a decreasing trend for hypopharyngeal cancer.

Conclusions

The age-standardized rate and trend of respiratory system cancers are increasing. Therefore, it is important to prevent their prevalence by reducing the risk factors and increasing the general awareness of risks and timely diagnosis.