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Objective: To investigate the clinical features, treatment strategy and risk factors affecting the prognosis of elderly patients with non-small cell lung cancer (NSCLC) complicated by chronic obstructive pulmonary disease (COPD)., Methods: We retrospectively analyzed the data of elderly patietns (>60 years) with newly diagnosed NSCLC complicated by COPD at the Geriatric Institution of General Hospital of PLA between January, 2000 and June, 2015. The clinical data collected included history of smoking, pulmonary function test results, initial treatments, TNM stage, chief complaints, comorbidities and laboratory tests. The Cox proportional hazards regression model was used to explore the prognostic factors in these patients., Results: A total of 200 NSCLC patients were reviewed, of which 107 (53.5%) patients had the co-morbidity of COPD as confirmed by spirometry using bronchodilator test. The median survival of the patients with NSCLC complicated by COPD was 45.8 months with 1-, 3-, 5-, and 10-year survival rates of 80.4%, 55.4%, 41.0% and 20.0%, respectively. Stratification analysis showed that patients with COPD Gold grades 1 and 2 had a significant longer median overall survival (51.7 and 43.1 months, respectively) than those with grade 3/4 (16.9 months; P=0.020 and 0.043, respectively). Univariate and multivariate analyses using Cox proportional hazards regression model showed that an older age, a higher Gold grade, advanced disease stage (stages III and IV), squamous cell carcinoma, nonsurgical initial treatment, coughing and an elevated serum CEA level were independent risk factors for shorter survival of the patients., Conclusion: Multiple prognostic factors can affect the outcomes of elderly patients with NSCLC complicated by COPD, and a higher COPD Gold grade that fails to respond to treatment within 3 months is the independent risk factor for survival of the patients.

Objective: To comprehend ventilator-associated pneumonia (VAP) caused by pneumocystis carinii (P. carinii-VAP) in the non-human immunodeficiency virus (HIV) infected patients., Methods: The clinical data of 5 patients with P. carinii-VAP in the non-HIV patients from 2000 to 2003 in our hospital were reviewed., Results: Five male patients, aged 71 - 93, had severe predisposing diseases and respiratory failure induced by lung infection. All patients were treated with mechanical ventilation and multiple antibiotics and had recurrent VAP. Fever was present in all patients together with respiratory symptoms. Moist rales were noted in four of them. X-ray showed diffuse patchy shadows in 4 patients, extensive densities in 1 cases, reticular infiltrations in 2 cases, and pleural effusion in 2 cases. Sputum P. carinii was found by smear staining in 4 cases as well as a positive PC PCR. The remaining case only showed a positive PC PCR. Four patients were cured after treatment with SMZco, but one patient died., Conclusion: P. carinii-VAP could occur during prolonged mechanical ventilation for severe respiratory diseases, particularly in aged patients with advanced cancer or treated with glucocorticoids and broad spectrum antibiotics.