No impact of rheumatic diseases on lung cancer survival
medwireNews: The presence of autoimmune rheumatic diseases is not associated with worse survival outcomes among patients with lung cancer, researchers report.
These findings are based on a review of medical records from 177 patients with biopsy-proven lung cancer and one or more rheumatic diseases – most commonly rheumatoid arthritis (54.8%), systemic sclerosis (24.3%), and systemic lupus erythematosus (8.5%) – and 219 control lung cancer patients without rheumatic disease who received care at a single US academic medical center between 2003 and 2019.
The majority of patients in both groups had lung adenocarcinoma (55.9–72.1%), followed by squamous cell carcinoma (13.7–16.4%), small-cell lung cancer (5.9–9.6%), and non-small-cell lung cancer not otherwise specified (4.6–7.6%).
As reported in JAMA Network Open, there was no significant difference in the median duration of overall survival (OS) among patients with and without rheumatic diseases, at 48.43 months and 39.62 months, respectively, for locoregional disease, and 9.96 versus 19.09 months for distant disease.
At 1 year, OS rates were a comparable 85.41% in the rheumatic disease group and 87.59% in the control group for locoregional disease; the corresponding rates for distant disease were 44.05% and 58.44%.
When the different rheumatic diseases were analyzed separately, Victoria Villaflor (Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA) and co-authors say that “[n]o group of autoimmune disease showed statistically better or worse survival than the overall autoimmune cohort or the control cohort.” There was also no significant association between the presence of autoimmunity-associated interstitial lung disease and survival outcomes.
Despite no differences in survival between people with and without rheumatic diseases, “we noted a difference in the number of patients undergoing standard-of-care lung cancer treatment,” remark the researchers. Just 69.5% of rheumatic disease patients received local standard treatment, compared with 97.3% of those in the control group.
Villaflor and team say that “[t]he lack of difference in overall survival despite significant differences in treatment patterns between groups is intriguing and raises the possibility of a protective role of autoimmune disease.” However, they say that “such a conclusion is beyond the scope of the current study,” and highlight the need for further research, “particularly studies that can control for differences in treatment practices between groups.”
Writing in an accompanying commentary, Elizabeth Volkmann (University of California, Los Angeles, USA) says that the study “provides compelling evidence that the existence of an autoimmune condition does not adversely affect survival in patients with lung cancer.”
She recommends that future studies should “evaluate whether specific immunomodulatory agents used to treat autoimmune conditions as well as the duration of immunomodulatory therapy affect lung cancer survival rates in these patients,” in order to “help guide future therapeutic efforts.”
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