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Survival impact of treatment for chronic obstructive pulmonary disease in patients with advanced non-small-cell lung cancer

Ajimizu, Hitomi 京都大学 DOI:10.14989/doctor.k24193

2022.09.26

概要

肺癌患者において、慢性閉塞性肺疾患（COPD）はしばしば合併する呼吸器疾患である.COPDの併存は呼吸困難や増悪,予後不良を引き起こす可能性があるが,進行期肺癌患者において,COPDの併存が及ぼす影響は不明である.また,COPD患者において，吸入療法の進歩により予後・生活の質（QOL）の改善が報告されているが,COPDに対する薬物治療が肺癌患者の予後を改善するかについては明らかではない.

本研究では,COPDを合併した進行期非小細胞がん（NSCLC）患者の予後がCOPDに対する治療介入により改善すると仮説し，2007年から2014年に京都大学医学部附属病院で化学療法を受けた進行期NSCLC患者を対象とした.COPD合併の有無は喫煙歴と肺機能検査で判断し,COPDに対する薬物治療と全生存期間（OS）の関連を後方視的に検討した.2007年から2014年の間に進行期NSCLCに対して化学療法が行われた550名のうち,肺機能検査を受けた347名が解析対象となり，103名（29.7%）がCOPD合併患者であった.OS中央値はCOPD群が非COPD群より有意に短縮していた（10.6か月対16.8か月,P=0.0002）.COPD患者103名のうち37名（35.9％）の患者は吸入ステロイド,長時間作動型β刺激薬,長時間作動型抗コリン薬の単剤もしくは合剤によるCOPD吸入療法を受けていた.薬物治療を受けていた患者は治療を受けていない患者と比較し,OS中央値が有意に延長していた（16.7か月対8.2か月,P=0.023）.多変量Cox回帰分析により,COPD治療が予後に影響を与える独立した因子であることが確認された(HR=0.52(0.31–0.87),P=0.0134).追加検討として,近年,進行期肺癌では免疫チェックポイント阻害剤（ICI）を用いた治療が主流になっていることから,ICI治療患者におけるCOPD合併及び治療の有無についての後方視的検討を行った.2016年から2019年にかけて京都大学医学部附属病院でICIを含む化学療法がおこなわれた進行期NSCLC患者は168名であり，肺機能検査を受けた患者115名（63.1％）を対象とした.対象患者のうち,42名（36.5％）がCOPD合併患者であり,うち14名がCOPD吸入療法を受けていた.吸入療法を受けていた患者は治療を受けていない患者と比較し,OS中央値が有意に延長していた（16.7か月対8.2か月,P=0.0355).

以上の検討により進行期NSCLC患者において,COPDの吸入治療の有無はCOPD合併肺癌の予後と有意に関連することが示された.併存するCOPDに対する吸入治療は,進行期NSCLC患者の予後を改善する可能性がある.

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