Pulmonary function test for chronic obstructive pulmonary disease patients with non-small cell lung cancer


DOI: https://dx.doi.org/10.18565/therapy.2021.8.46-53

Shuginova T.N., Meldo A.A., Shaporova N.L., Moiseenko F.V., Klikunova K.A.

1) Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia; 2) Saint Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Aid (oncological); 3) I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia, Saint Petersburg; 4) Saint Petersburg State Pediatric Medical University of the Ministry of Healthcare of Russia
Abstract. The combination of COPD and lung cancer according to different studies occurs in 22–60% of cases.
The aim of the study: to determine the relationship between functional and structural pulmonary changes in patients with lung cancer and COPD.
Material and methods. The study included data on 41 patients with non-small cell lung cancer (NSCLC). The age of the patients varied from 38 to 83 years; the mean age was 62,2±10,2 years (95% confidence interval (CI): 58,9–65,4). 27 (65.9%) patients were men, 14 (34.1%) patients were women, the gender ratio was 1.9:1. All the patients with NSCLC were orderly divided into two groups, similar in comorbidity: 27 (65,9%) patients with COPD and 14 (34,1%) patients without COPD. 24 (58,5%) patients had a smoking experience of 13 years or more. 17 (41,5%) patients did not smoke. All the patients underwent functional tests on a MasterScreen Pneumo spirometer and paired inspiratory-expiratory chest CT scan (IECT). Axial IECT images were supplemented with multiplanar reconstruction.
Results. The diagnosis of COPD was confirmed in 27 (65,9%) patients with non-small cell lung cancer (NSCLC). The relationship between the degree of obstruction and the fact of smoking was statistically significant (p=0,002). The frequency of obstructive disorders in the group of smokers was significantly higher than in the group of nonsmokers (p=0,008). Comparison of the tumour-affected lung (L) and the “healthy” lung (L) showed that there is a negative linear relationship between the gradient of lung tissue density during inhalation and exhalation and FEV1. It is more significant (r=-0,640; p <0,001) for the affected side, and it is moderate (r=-0,497; p=0,001) for the contralateral side. Correlation analysis showed the dependence of the relationship between the density gradient and FEV1 on gender and the fact of smoking. The mean density gradient in male patients was significantly reduced on the side of the affected lung and correlated with the pack-years index (ρ=0,613; p=0,001).
Conclusion. The performed statistical analysis revealed a correlation between the functional state and structural changes in the lung tissue detected by inspiratory-expiratory computed tomography and spirometry that can be used in a comprehensive examination of patients with NSCLC and comorbid COPD for treatment planning.
Keywords: non-small cell lung cancer, comorbidity, chronic obstructive pulmonary disease, smoking
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About the Autors

Tatyana N. Shuginova, doctor of the highest qualification category, head of the Department of functional diagnostics and general therapy, Saint Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Aid (oncological), assistant at the Department of general medical practice (family medicine), Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197758, Saint Petersburg, 68А Leningradskaya Str. Tel.: +7 (911) 949-85-61. E-mail: shuginova@mail.ru
Anna A.Meldo, PhD, head of the Department of radiation diagnostics, Saint Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Aid (oncological). Address: 197758, Saint Petersburg, 68А Leningradskaya Str. Tel.: +7 (904) 644-17-02. E-mail: anna.meldo@yandex.ru
Natalia L. Shaporova, MD, professor, head of Department of general medical practice (family medicine), Academician I.P. Pavlov First Saint Petersburg State Medical University of the Ministry of Healthcare of Russia. Address: 197022, Saint Petersburg, 6–8 Lva Tolstogo Str. Tel.: +7 (921) 758-98-74. ORCID: 0000-0002-6457-5044
Fedor V. Moiseenko, MD, associate professor of the Department of oncology, I.I. Mechnikov North-Western State Medical University of the Ministry of Healthcare of Russia, head of the Department of chemotherapy, Saint Petersburg Clinical Scientific and Practical Center for Specialized Types of Medical Aid (oncological). Address: 197758, Saint Petersburg, 68А Leningradskaya Str. Tel.: +7 (911) 919-26-88. E-mail: moiseenkofv@gmail.com
Ksenia A. Klikunova, candidate of physical and mathematical sciences, associate professor of the Department of medical physics, Saint Petersburg State Pediatric Medical University of the Ministry of Healthcare of Russia. Address: 194100, Saint Petersburg, 2 Litovskaya Str. Tel.: +7 (921) 630-06-20. E-mail: kliksa@gmail.com


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