Impact of COPD pulmonary structural remodeling on the prognosis of patients with advanced lung squamous cell carcinoma

BACKGROUND: By observing the changes of lung imaging airway structure in patients with advanced lung squamous cell carcinoma（ALUSC）, the relationship between the different types of COPD pulmonary structural remodeling and the prognosis of patients with ALUSC was analyzed. METHODS: We reviewed the medical records of 278 patients with ALUSC. The degree of emphysema and the percentage of bronchial wall thickness（WT%） on chest HRCT were calculated by Synapse3D software, Lung structural remodeling can be divided into there types: airway remodeling dominated, emphysema dominated, and mixed types. RESULTS: Compared with the diagnosis, the Goddard score increased, the proportion of airway remodeling dominated type decreased and the proportion of mixed type increased during the progression of ALUSC. In Kaplan-Meier analysis, whether with or without COPD, the mPFS and mOS of patients with mixed type were the shortest, and the difference was statistically significant. Univariate and multivariate Cox proportional hazard regression analysis showed that mixed type was an independent risk factor for poor PFS and OS in patients with ALUSC. CONCLUSION: Patients with ALUSC all have varying degrees of lung structural remodeling, and patients with mixed lung structural remodeling have the worst prognosis. In addition, the aggravation of emphysema during tumor progression is more pronounced than the thickening of the airway wall, and the changes of emphysema was more powerful in predicting the progression of ALUSC.Clinicians must pay more attention to the changes of COPD (especially emphysema) in the process of diagnosis and treatment of ALUSC.