Meta-analysis Of Clinical Features Of COPD Complicated With Lung Cancer

Objective:To analyze the smoking history,smoking index,clinical symptoms,imaging manifestations and Lung function characteristics of patients with chronic obstructive pulmonary disease combined with lung neoplasms and patients with COPD alone,and to explore the differences between them.To provide evidence-based medical evidence for the establishment of high risk population of lung cancer in COPD,in order to improve the early diagnosis rate of lung cancer.Methods:Pub Med,Embase,Cochrane Library,Web of Science,CNKI,VIP Database,Wan Fang and CBM were searched by computer.Case-control studies on clinical characteristics of patients with COPD combined with lung cancer and COPD alone published from the establishment of the database to October 2021 were collected and meta-analysis was conducted.Observation group was COPD patients with lung cancer,control group was COPD patients,The indicators were smoking history,smoking index（≥ 400,< 400）,main clinical symptoms（cough,expectoration,dyspnea,hemoptysis,chest pain,wasting,fatigue,hoarseness）,imaging findings（pleural effusion,atelectasis）and lung function characteristics（GOLD grade,DLCO,RV/TLC）.Literature selection,quality evaluation and data extraction were carried out according to the inclusion and exclusion criteria.Review Manager 5.4 software was used for statistical analysis,forest map was drawn for data combined effect size,Q2 test or I2 test was used for heterogeneity evaluation,single study method was removed for sensitivity analysis,Z test was used to evaluate the statistical results of combined effect size,and finally publication bias was evaluated by funnel plot.Results:A total of 19 literatures were included in this meta-analysis,including 4747patients（1663 patients with COPD combined with lung cancer and 3084 patients with COPD alone）.Meta-analysis showed that the incidence of smoking history in the COPD combined with lung cancer observation group was higher than that in the control group [OR = 3.26,95%CI（2.37,4.48）],and the difference was statistically significant.The incidence of smoking index ≥ 400 in the observation group was higher than that in the control group [OR = 2.78,95%CI（1.91,4.03）],while the incidence of smoking index < 400 in the observation group was lower than that in the control group [OR = 0.52,95%CI（0.40,0.67）],and the difference was statistically significant.The main clinical symptoms of patients in the observation group were hemoptysis [OR = 13.24,95%CI（10.37,16.90）],chest pain [OR = 5.49,95%CI（4.2,7.15）],emasmus [OR = 8.34,95%CI（6.48,10.73）],fatigue [OR = 2.36,The incidence of 95%CI（1.86,2.99）] and hoarseness [OR = 7.86,95%CI（3.92,15.78）]were higher than that of the control group,and the difference was statistically significant.There was no significant difference in the incidence of cough,expectoration and dyspnea between the two groups（P = 0.96;P = 0.15;P = 0.20）;Imaging manifestations were compared between the two groups.The incidence of pleural effusion [OR = 4.36,95%CI（3.55,5.36）] and atelectasis [OR = 14.26,95%CI（9.48,21.44）] in the observation group was higher than that in the control group,and the difference was statistically significant.Comparison of lung function between 2groups showed that the incidence of GOLD grade（I+II）in the observation group was higher than that in the control group [OR = 1.68,95%CI（1.03,2.73）],while the incidence of GOLD grade（III+IV）in the observation group was lower than that in the control group [OR = 0.57,95%CI（0.36,0.91）].The difference was statistically significant.DLCO [MD =-7.80,95%CI（-9.81,-5.80）] and RV/TLC[MD =-3.29,95%CI（-4.67,-1.90）] in the observation group were lower than those in the control group,and the difference between the two groups was statistically significant.Conclusion :1、Smoking is a risk factor for COPD combined with lung cancer,especially for COPD patients with smoking index ≥400,smoking cessation should be strengthened and lung cancer screening should be performed regularly.2、The clinical symptoms of patients with COPD combined with lung cancer overlap with those of patients with COPD alone,but when patients with COPD appear hemoptysis,chest pain,emaciation,fatigue and hoarseness and other clinical manifestations as well as the imaging characteristics of pleural effusion and atelectasis,we should be alert to the possibility of combined lung cancer.3、Lung function has certain suggestive significance for the diagnosis of COPD combined with lung cancer.Lung cancer screening should be improved regularly for COPD patients with GOLD grade（I+II）and poor diffusion function.