EXPRESS: Impact of Atrial Arrhythmias on Long-Term Survival in Non-small Cell Lung Cancer Patients

Atrial arrhythmias (AA) including atrial fibrillation (AF) and atrial flutter (AFL) are significant clinical problem in oncological patients. The effect of AA on clinical outcome of patients with non-small cell lung cancer (NSCLC) is not well-known. We assessed the impact of AA on overall survival (OS) in patients with NSCLC. All consecutive NSCLC patients with baseline FDG-PET/CT in our institutional cancer registry from 2004 to 2017 were included. The incidence and prevalence of AA were determined. Cox regression models and Kaplan-Meier survival curves were used for the analysis. A total of 998 NSCLC patients (mean age 67 years, 54.3% female, 45.5% African American) were enrolled. AA were documented in 142 patients (14.2%); 6.9% had baseline AA and 7.3% had new-onset AA during the treatment of NSCLC. Baseline AA was more common in older, male, white and comorbid patients. Univariate analysis showed baseline AA was associated with worse OS compared to no AA (HR 1.48, p=0.004), whereas new-onset AA did not significantly impact OS (HR 1.02, p=0.875). Baseline AA was associated with worse OS compared to new-onset AA (HR 1.45, p=0.044). In multivariate analysis, baseline AA remained an independent predictor of worse OS (HR 1.59, p=0.001) after adjusting nine prognostic variables including TNM stage, treatment, whole-body metabolic tumor volume, and performance status. New-onset AA did not affect OS (HR 1.16, p=0.30). In conclusion, baseline AA is an independent prognostic marker for worse OS in NSCLC patients, while new-onset AA does not have impact on OS.