Surgical outcomes and prognosis of non-small-cell lung cancer in patients with chronic lung diseases: a retrospective analysis

OBJECTIVES: Lung cancer treatment in patients with chronic lung diseases is challenging because postoperative care is difficult and surgical outcomes are poorer than in patients with healthy lungs. This study aimed to examine postsurgical outcomes of patients with comorbid lung diseases treated for lung cancer. METHODS: This retrospective study enrolled 1526 patients who underwent curative surgical resection for non-small-cell lung cancer at a single centre between October 2008 and April 2017. Based on computed tomography findings, patients were assigned to 4 groups and their demographic characteristics, clinicopathological features, surgical outcomes and survival were compared. RESULTS: There were 1101 patients in group A, 266 patients in group B, 62 patients in group C and 97 patients in group D. In the chronic lung disease groups (B, C and D), there was a high percentage of smoking history (86.5%, 79.0% and 92.8%, respectively; P<0.01). The occurrence rate of postoperative lung complications and operative mortality rates were higher in patients with chronic lung disease. Groups A, B, C and D contained 819 (74.4%), 159 (59.8%), 43 (69.4%) and 65 (67.0%) stage I patients, respectively (P<0.01). The groups showed significant differences in overall survival and disease-free survival (all P<0.01). The presence of combined pulmonary fibrosis and emphysema was the only significant negative prognostic factor for overall survival. CONCLUSIONS: The presence of comorbid chronic lung diseases might negatively affect prognosis in patients with non-small-cell lung cancer. The presence of combined pulmonary fibrosis and emphysema could be a negative prognostic factor in lung cancer treatment.