Arch Bronconeumol. 2020 Aug 29. pii: S0300-2896(20)30256-8. [Epub ahead of print]
INTRODUCTION: The impact of preoperative nutritional status on survival in lung cancer (LC) patients with underlying chronic obstructive pulmonary disease (COPD) is still unclear. We hypothesized that presurgical nutritional assessment may differentially predict mortality in patients with resectable LC with moderate COPD and relatively well-preserved nutritional status.METHODS: Nutritional assessment [body mass index (BMI), blood parameters including albumin and protein levels, and body weight loss], and other clinical parameters [cigarette smoking (CS) history, LC staging and histological subtypes, COPD severity, lung function, and adjuvant therapy] were evaluated in 125 patients from the LC Mar Prospective Cohort: 87 LC-COPD patients and 38 LC patients without COPD before thoracotomy. Ten-year overall survival (OS) was analyzed in all patients.
RESULTS: Prior to thoracotomy, in LC-COPD patients compared to LC, BMI and albumin declined relatively, low levels of the parameters BMI, albumin, and total proteins were associated with poorer 10-year survival, especially in the LC-COPD. CS burden also correlated with impaired survival. COPD per se worsened the prognosis in LC patients.
CONCLUSIONS: In the present cohort of LC patients with resectable tumors and relatively well-preserved nutritional status, the parameters BMI and blood albumin and protein levels measured prior to thoracotomy predicted OS, especially in those with COPD. These are clinically relevant findings, since values of those nutritional parameters were within the normal ranges in the majority of the analyzed patients. A thorough nutritional preoperative assessment should be included in the study of patients with resectable LC, particularly in those with chronic airway obstruction.
ABBREVIATIONS: BMI, body mass index; LC, lung cancer; COPD, chronic obstructive pulmonary disease; Hi, high level (above cut-off value); Lo, low level (below cut-off value).
Keywords: COPD; EPOC; albúmina en sangre; blood albumin; blood total proteins; cáncer de pulmón; estado nutricional; lung cancer; nutritional status; overall survival; proteínas totales en sangre; supervivencia global