Brief Report: Emphysema as a Prognostic Factor in Patients With Advanced NSCLC With COPD Receiving Immune Checkpoint Inhibitors

Abstract

Introduction: Chronic obstructive pulmonary disease (COPD) and emphysema are independent risk factors for lung cancer development and have been independently associated with longer overall survival (OS) in patients with NSCLC treated with immune checkpoint inhibitors (ICIs). However, their combined impact on prognosis remains unclear. This study evaluates emphysema as a prognostic factor in patients with COPD with advanced NSCLC (aNSCLC) undergoing immunotherapy. Methods: This study included patients with aNSCLC with COPD (defined by spirometry) treated with single-agent ICI as first-or second-line treatment, from 2013 to 2024. Patients were classified based on visually detected emphysema on chest computed tomography. Results: The study included 111 patients with COPD, of whom 77 had coexisting emphysema. Patients with COPD and emphysema had significantly longer OS compared with those without emphysema (17.3 versus 8.5 mo, p = 0.008), with a nonsignificant trend toward improved progression-free survival (3.3 versus 2.4 mo, p = 0.641). Emphysema remained an independent factor of better OS in multivariate analysis (hazard ratio: 0.49; 95% confidence interval: 0.30-0.81). Adverse event rates were similar regardless of emphysema status (p = 0.455). Conclusions: This study suggests that visually detected emphysema on chest computed tomography could be a potential prognostic marker in patients with aNSCLC with COPD receiving ICIs. Further studies are guaranteed to confirm these findings.