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Background: Neoadjuvant immune checkpoint inhibitors(ICIs) combined with chemotherapy can improve non-small cell lung cancer(NSCLC) patients' pathological responses and show promising improvements in survival. Chronic obstructive pulmonary disease (COPD) is a systemic inflammatory disease, and its associated abnormal inflammatory response affects not only the immunotherapy efficacy but also immune-related adverse events. It remains unclear whether NSCLC patients with COPD can benefit from neoadjuvant ICIs combined with chemotherapy. Methods: A retrospective observational clinical study was conducted on 105 consecutive NSCLC patients receiving neoadjuvant ICIs combined with chemotherapy at the Department of Thoracic Surgery of Tianjin Chest Hospital between April 2020 and April 2023. Results: A total of 74 NSCLC patients were included in the study, including 30 patients with COPD and 44 patients without COPD. The percentage of patients with a pathological complete response (PCR) was higher in the COPD group than in the non-COPD group (43.3% vs. 20.5%, P = 0.042). Multivariate logistic regression analysis of factors associated with PCR showed that the adjusted odds ratio (OR) was statistically significant for presence of COPD (OR = 3.020, 95%CI: 1.042–8.757; P = 0.042). Major pathological response (66.7% vs. 50%, P = 0.155), R0 resection rate (96.7% vs.93.2%, P = 0.642), N2 lymph node downstaging(92.3% vs. 66.7%, P = 0.182) and objective response rate (70% vs. 63.6%, P = 0.57) were not significantly different between the groups. Progression-free survival(PFS) was not reached in the COPD group and 17 months (95%CI: 12.1–21.9) in the non-COPD group, with statistically significance (χ2 = 6.247, P = 0.012). Multivariate Cox's regression analysis showed that the adjusted hazard ratio (HRadj) was statistically significant for presence of COPD (HRadj = 0.321, 95%CI: 0.111–0.930; P = 0.036). The grade 3 and grade 4 adverse events in the COPD group were leukopenia (3.3%, 6.7%), neutropenia (3.3%, 6.7%), fatigue (6.7%, 0%), gastrointestinal reactions (3.3%, 0%), and hypothyroidism (3.3%, 0%). In the non-COPD group, the corresponding adverse events were leukopenia (6.8%, 6.8%), neutropenia (3.3%, 6.8%), fatigue (2.3%, 0%), gastrointestinal reactions (2.3%, 0%), and hypothyroidism (2.3%, 0%), respectively. Conclusions: The present study indicates that the presence of COPD may improve PCR, prolong PFS, and have an acceptable safety profile in NSCLC patients receiving neoadjuvant ICIs combined with chemotherapy. [ABSTRACT FROM AUTHOR]

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with poor prognosis in non‐small cell lung cancer (NSCLC) patients. There are limited data about the impact of severe‐to‐very severe COPD on prognosis in patients with NSCLC receiving first‐line chemotherapy. Objectives: To investigate whether severe‐to‐very severe COPD impacted survival of patients with NSCLC receiving first‐line chemotherapy. Methods: A retrospective review was performed on 513 consecutive NSCLC patients receiving first‐line chemotherapy between February 2014 and May 2018. Prognostic impact of severe‐to‐very severe COPD was analysed using regression analyses. Results: Totally 258 NSCLC patients (118 non‐COPD, 96 mild‐to‐moderate COPD and 44 severe‐to‐very severe COPD) were evaluated retrospectively. Kaplan‐Meier analysis showed that the median overall survival times in the severe‐to‐very severe COPD, mild‐to‐moderate COPD and non‐COPD groups were 14.0 months [95% confidence interval (CI): 11.0‐17.0], 18 months (95% CI: 14.8‐21.2) and 19 months (95% CI: 15.3‐22.7), respectively. The difference was significant between patients with severe‐to‐very severe COPD and those without COPD (χ2 = 6.8, P = 0.009) and between patients with severe‐to‐very severe COPD and those with mild‐to‐moderate COPD (χ2 = 4.0, P = 0.045). Multivariate analysis showed that survival time was significantly shorter in the severe‐to‐very severe COPD group than in the non‐COPD group (adjusted hazard ratio: 1.876, 95% CI: 1.161‐3.030, P = 0.01) and mild‐to‐moderate COPD group (adjusted hazard ratio: 1.782, 95% CI: 1.046‐3.034, P = 0.033). Conclusion: Severe‐to‐very severe COPD may worsen the prognosis of NSCLC patients who received first‐line chemotherapy. [ABSTRACT FROM AUTHOR]