The following article is a part of conference coverage from the American Thoracic Society International Conference, being held virtually from May 14 to May 19, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the ATS 2021 .

Patients with lung cancer and poor pulmonary function at diagnosis have worse rates of overall survival, according to study results presented at the American Thoracic Society International Conference, held virtually from May 14 to May 19, 2021.

As pulmonary function is a risk factor for all-cause mortality, and chronic obstructive lung disease (COPD) is associated with lower rates of overall survival among patients with lung cancer, preoperatively assessing patient lung function can help predict in-hospital perioperative lung cancer mortality, according to the researchers of the current study. Still, the predictive ability of such assessments is unclear.

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Therefore, the investigators sought to clarify how pretherapeutic pulmonary function could predict the overall survival of patients with lung cancer by assessing the association between pulmonary function tests (PFTs) and overall survival; comparing overall survival across spirometry-defined Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages of COPD; and conducting a meta-analysis of published data on the association between PFTs and overall survival. The retrospective analysis included data taken from the Boston Lung Cancer Study (1992-2020). These patients were newly diagnosed and had PFT performed before lung cancer therapy.

Among the patients in the analytical cohort (mean age, 66.7 years; 48.9% men; 88.2% smokers), the overall 5-year survival rate was 51.5%. In a dose-response relationship across univariate and multivariate models, lower quartiles of forced vital capacity (FVC), actual and predicted forced expiratory volume in 1 second (FEV1), peak expiratory flow rate, and diffusing capacity for carbon monoxide were all significantly associated with worse overall survival.

For patients without COPD, median survival was 73.6 months (95% CI, 66.2-83.4); for patients in GOLD stage 1, median survival was 68.4 months (95% CI, 53.1-73.8); for patients in stage 2, median survival was 51.4 months (95% CI, 46.6-58.0); for patients in stage 3, median survival was 34.2 months (95% CI, 26.2-43.5); and for patients in stage 4, median survival was 26.7 months (95% CI, 13.9-41.5 months). When PFTs in the lower category were compared with the higher category, meta-analysis showed a pooled hazard ratio of 1.48 (95% CI, 1.35-1.61).

Study investigators concluded, “Lung cancer patients with poor pulmonary function at diagnosis have worse [overall survival]. Improvement in lung function before initiating lung cancer therapy could provide a long-term survival benefit.”


Zhai T, Christiani DC. Association between pulmonary function tests and overall survival in patients with lung cancer. Presented at: the American Thoracic Society (ATS) International Conference 2021; May 14-19, 2021. Abstract A4609.

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