The association between cirrhosis and outcomes among patients with lung cancer in Ontario between 2007 and 2017: a population-based study

Introduction — We describe the association between cirrhosis and outcomes among patients treated for non-small cell lung cancer (NSCLC).

Methods — NSCLC cases in 2007–2017 in Ontario, Canada, were reviewed. Cirrhosis was identified using validated coding. The association between cirrhosis and outcomes was evaluated using logistic regression, Kaplan–Meier curves, and adjusted survival models.

Results — Among patients with stage 1–3 NSCLC receiving lung resection (n = 59,226), 3% had cirrhosis with higher 30-day (5% versus 2%, p < 0.001) and 90-day (8% versus 3%, p < 0.001) mortality. After multivariable logistic regression, cirrhosis was associated with higher mortality odds at 30 days (OR 2.35, 95% CI 1.39–3.99, p < 0.001) and 90 days (OR 2.10, 95% CI 1.38–3.21, p < 0.001); higher 90-day post-operative complications odds (OR 1.44, 95% CI 1.14–1.81, p = 0.002); and higher hospital readmission odds at 30 days (OR 1.90, 95% CI 1.41–2.56, p < 0.001) and 90 days (OR 1.63, 95% CI 1.27–2.10, p = 0.001). Among those with stage 4 NSCLC (n = 27,357), adjusted Cox regression showed cirrhosis was associated with higher mortality (HR 1.10, 95% CI 1.02–1.18, p = 0.016). However, when liver-related mortality was a competing event, association between cirrhosis and cancer-specific mortality was absent (sHR 1.04, 95% CI 0.95–1.13, p = 0.395). A lower proportion of patients with cirrhosis received systemic treatments (31% versus 40%, p < 0.001), and a greater proportion experienced post-treatment complications: electrolyte disturbances (10% versus 5%, p < 0.001), kidney injury (5% versus 2%, p = 0.012), and thrombocytopenia (7% versus 2%, p < 0.001).

Conclusions — Cirrhosis is associated with increased morbidity and mortality in stage 1–3 NSCLC patients undergoing curative surgery. Stage 4 NSCLC patients with cirrhosis are less likely to receive palliative treatment and may experience more post-treatment complications.