Forced expiratory volume in one second as a prognostic factor in advanced non-small cell lung cancer

Reduced lung function is an important risk factor for lung cancer and increases surgical risk in patients with operable stages of lung cancer. Nevertheless, there have been few studies to reveal association of lung function with mortality in patients with advanced lung cancer. The aim of this study was to investigate whether low forced expiratory volume in 1 second (FEV ₁) is an independent predictor of mortality in patients with advanced lung cancer. Methods: Data were retrospectively collected from patients with non-small cell lung cancer of stage IIIB or IV and available spirometry at diagnosis of lung cancer. They had the last follow-up consecutively between April 2003 and July 2009 in a tertiary referral hospital. Results: Among a total of 156 patients, 118 died as of July 2009. Their mean age was 65 years; 115 (74%) were men. Mean FEV₁ was 1.91 liters (79% of predicted). Seventy-one patients (46%) had adenocarcinoma, and 48 (31%) had squamous cell carcinoma. In a multivariate analysis using Cox regression model, independent prognostic factors were FEV₁ less than 50% of predicted (hazard ratio [HR] = 2.704, 95% confidence interval [CI]: 1.516-4.823, p = 0.001), chemotherapy (HR = 0.311, 95% CI: 0.192-0.503, p < 0.001), adenocarcinoma (HR = 0.459, 95% CI: 0.300-0.701, p < 0.001), body mass index (HR = 0.921, 95% CI: 0.870-0.975, p = 0.005), and the presence of malignant pleural effusion (HR = 1.673, 95% CI: 1.102-2.540, p = 0.016). Conclusions: Reduced FEV₁ is strongly associated with mortality in advanced non-small cell lung cancer.