Cancer Management and Research (Jun 2021)
Survival of Patients with Lung Cancer in the Setting of Liver Cirrhosis: A Multicenter Propensity Score Matching Study
Abstract
Ming-Shian Lu,1 Hung-I Lu,2 Tzu-Ping Chen,3 Che-Chia Chang,1 Tsung-Ming Yang,4 Miao-Fen Chen5,6 1Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan; 2Division of Thoracic and Cardiovascular Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan; 3Division of Thoracic and Cardiovascular Surgery, Keelung Chang Gung Memorial Hospital, Keelung City, Taiwan; 4Division of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan; 5Department of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, Puzi, Chiayi County, Taiwan; 6College of Medicine, Chang Gung University, Taoyuan City, TaiwanCorrespondence: Miao-Fen ChenDepartment of Radiation Oncology, Chiayi Chang Gung Memorial Hospital, No. 6, Sec. West, Jiapu Road, Puzi City, Chiayi County, 61363, TaiwanTel +886 5 362100 Ext 2011Fax +886 5 3623002Email [email protected]: The survival outcome of lung cancer patients with coexisting liver cirrhosis has thus far received limited attention in the literature. In this study, we evaluated whether liver cirrhosis is an independent risk factor for the survival of patients with lung cancer.Materials and Methods: We conducted a retrospective, multicenter, propensity-matched study of lung cancer patients with and without liver cirrhosis. To determine differences in survival, we sought to identify risk factors associated with poor outcomes using Kaplan–Meier survival analysis and Cox proportional hazards regression.Results: There were no statistically significant differences in the baseline clinical characteristics of patients between the cirrhosis and non-cirrhosis groups. The median overall survival of patients with and without cirrhosis was 13.07 months (95% confidence interval [CI]: 10.56– 16.84) and 13.67 months (95% CI: 10.42– 16.91), respectively (p=0.76). Cox proportional hazards regression analysis revealed that liver cirrhosis was not an independent risk factor for poor outcome (hazard ratio [HR]: 1.057, 95% CI: 0.805– 1.388, p=0.690). In patients with cirrhosis, lower serum albumin levels, higher Charlson Comorbidity Index score, advanced-stage lung cancer, and treatment modality were factors associated with poor outcome. Increase in serum albumin by 1 g was associated with a 30% reduction in the risk of mortality (HR: 0.700, 95% CI: 0.494– 0.993, p=0.045). While every point increase in the Charlson Comorbidity Index score by 1 point was linked to a 9% higher risk of mortality (HR: 1.090, 95% CI: 1.023– 1.161, p=0.007).Conclusion: The survival rates of lung cancer patients with and without cirrhosis did not differ significantly. Higher serum albumin levels and lower Charlson Comorbidity Index scores were associated with improved survival.Keywords: liver cirrhosis, lung neoplasm, outcome, survival
