Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study

Baldi, S.; Ruffini, Enrico; Harari, Sergio; Roviaro, G. C.; Nosotti, Mario; Bellaviti, Nadia; Venuta, Federico; Diso, Daniele; Rea, Federico; Schiraldi, C.; Durigato, Alberto; Pavanello, M; Carretta, Angelo; Zannini, Piero

doi:10.1016/j.jtcvs.2005.06.049

Cited by 81 publications

(46 citation statements)

References 21 publications

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“…In contrast, the effect of surgery to resect the tumour might alter the prevalence of COPD. Studies examining lung function after lobectomy suggest that lung function is only mildly affected [23,24]. The results from our study are very similar to those from WIN et al [23], who in a similarly sized study reported pre-operative FEV1 of ,2 L, dropping on average 600 mL, compared with 400 mL in our study (table 3).…”

Section: Thoracic Oncology Rp Young Et Alsupporting

confidence: 90%

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Young¹,

Hopkins²,

Christmas³

et al. 2009

European Respiratory Journal

575

493

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Chronic obstructive pulmonary disease (COPD) is a common comorbid disease in lung cancer, estimated to affect 40-70% of lung cancer patients, depending on diagnostic criteria. As smoking exposure is found in 85-90% of those diagnosed with either COPD or lung cancer, coexisting disease could merely reflect a shared smoking exposure. Potential confounding by age, sex and pack-yr smoking history, and/or by the possible effects of lung cancer on spirometry, may result in over-diagnosis of COPD prevalence.In the present study, the prevalence of COPD (pre-bronchodilator Global Initiative for Chronic Obstructive Lung Disease 2+ criteria) in patients diagnosed with lung cancer was 50% compared with 8% in a randomly recruited community control group, matched for age, sex and pack-yr smoking exposure (n5602, odds ratio 11.6; p,0.0001).In a subgroup analysis of those with lung cancer and lung function measured prior to the diagnosis of lung cancer (n5127), we found a nonsignificant increase in COPD prevalence following diagnosis (56-61%; p50.45). After controlling for important variables, the prevalence of COPD in newly diagnosed lung cancer cases was six-fold greater than in matched smokers; this is much greater than previously reported.We conclude that COPD is both a common and important independent risk factor for lung cancer.KEYWORDS: Chronic obstructive pulmonary disease, epidemiology, lung cancer, risk, spirometry A s only 10-15% of chronic smokers get lung cancer [1], host susceptibility factors have been implicated. Age, smoking history, family history and impaired lung function have been identified as key risk factors [2]. The question that then arises is: does the association between chronic obstructive pulmonary disease (COPD) and lung cancer come down to more than a shared smoking history?Cross-sectional studies show that the prevalence of COPD is 40-70% of those diagnosed with lung cancer [3,4], although prevalence is highly dependent on diagnostic criteria, age, sex and smoking exposure [5]. As none of these studies compared the prevalence of COPD in their lung cancer cohorts with a smoking cohort matched for these variables, the significance of this finding is uncertain. Moreover, none of these studies considered that lung cancer may itself cause an obstructive effect on spirometry. It is possible that potential confounding by age, sex and packyr smoking history on COPD prevalence, and/or the possible effects of lung cancer per se on spirometry, could result in over-diagnosis of COPD and a falsely increased association between COPD and lung cancer.

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Section: Thoracic Oncology Rp Young Et Alsupporting

confidence: 90%

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Young¹,

Hopkins²,

Christmas³

et al. 2009

European Respiratory Journal

575

493

View full text Add to dashboard Cite

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“…These results indicate that the postoperative percent-of-predicted D LCO exhibits greater recovery compared with FEV 1 , which is similar to the findings reported by Brunelli et al 10 This finding may be explained by pulmonary vascular and hemodynamic compensatory mechanisms. 16 Several authors have reported that the percent-of-predicted FEV 1 in COPD subjects was decreased to a lesser extent or even improved after surgical resection compared with the percent-of-predicted FEV 1 in non-COPD subjects, [17][18][19] and the difference was more prominent at the early phase (1-3 months) after surgery. 10,20 This might be attributed to the similar effect of lung volume reduction surgery for subjects with bullous emphysema.…”

Section: Discussionmentioning

confidence: 99%

“…Further, it has also been noted that the actual postoperative percentof-predicted D LCO in subjects with COPD shows a marked increase with improvement of the ventilation/perfusion ratio. [17][18][19] In the present study, the actual percent-of-predicted FEV 1 had a tendency to exceed the predicted postoperative value in subjects with COPD (1.13 times the predicted postoperative value) at 1 month after surgery (P ϭ .06), but these values did not increase thereafter; meanwhile, the actual percent-of-predicted D LCO in COPD subjects showed no improvement, reaching only 73.5% of the preoperative value (1.05 times the predicted postoperative value) at 1 y after surgery. This inconsistency with the previous results may be due to the small number of COPD subjects (n ϭ 7) in our study.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

et al. 2015

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BACKGROUND: This study was conducted to measure the serial changes in pulmonary function over 12 months after lobectomy in subjects with lung cancer and to evaluate the actual recovery of pulmonary function in comparison with the predicted postoperative values. METHODS: Subjects who underwent lobectomy for primary lung cancer were included in this study. In the statistical analysis, we included data from 76 subjects (52 men and 24 women; mean age, 63.4 y) who completed perfusion scintigraphy 1 week before surgery and FEV 1 and diffusion capacity of the lung for carbon monoxide (D LCO ) assessments preoperatively and at 1, 6, and 12 months postoperatively. RESULTS: The actual percent-of-predicted FEV 1 1 month postoperatively was 77.9% of the preoperative value, which was almost equal to the predicted postoperative value, and significantly increased to 84.3% by 6 months and 84.2% at 12 months. The actual percent-of-predicted D LCO 1 month postoperatively was 81.8% of the preoperative value, which was similar to the predicted postoperative value, and also significantly increased to 91.3% at 6 months and 96.5% at 12 months. However, the actual pulmonary function test results at 1 y in subjects with COPD or in those who underwent thoracotomy or received adjuvant chemotherapy were not different from the predicted postoperative values. CONCLUSIONS: Actual pulmonary function compared with predicted postoperative values improved over time over 1 y after lobectomy. However, this improvement was not observed in subjects with COPD or in those who underwent thoracotomy or received postoperative adjuvant chemotherapy.

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“…Clinically, it is recommended that lung function be performed in early stage lung cancer in order to assess peri-operative risk and the impact of surgical resection on post-operative lung function and respiratory reserve [33,34]. Studies examining lung function after lobectomy suggest that lung function is only minimally affected [35]. In addition, in the prospective study by MANNINO et al [11], where lung function was performed at baseline and prior to lung cancer diagnosis, the prevalence of GOLD stage I+ COPD was 48% in incident lung cancer cases, which is comparable to that reported in studies where lung function was performed at the time of diagnosis [18][19][20].…”

Section: Demographic Variables and Genotypingmentioning

confidence: 99%

Lung cancer gene associated with COPD: triple whammy or possible confounding effect?

Young¹,

Hopkins²,

Hay³

et al. 2008

European Respiratory Journal

122

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Recently, several large genome-wide association studies have identified a putative ''lung cancer'' locus in the nicotinic acetylcholine receptor subunit genes (nAChR) on 15q25. However, these findings may be confounded by the presence of chronic obstructive pulmonary disease (COPD), which is also strongly associated with smoking exposure and lung cancer. This is likely as the prevalence of COPD in lung cancer cohorts is as much as two-fold greater than that reported in smoking control populations (50 versus 20%).The present authors compared the genotype frequencies of the most strongly associated single nucleotide polymorphism (rs16969968) in the a5 subunit of the nAChR gene cluster between three matched smoking cohorts.The AA genotype was found to be more frequent and was seen in 437 (16%) lung cancer cases and 445 (14%) COPD cases compared with 475 (9%) healthy smoking controls. More importantly, when 429 lung cancer cases were divided according to spirometry results (performed within 3 months of diagnosis, prior to surgery and in the absence of effusions or collapse), the AA genotype was present in 19 and 11% of cases with and without COPD, respectively.These findings suggest that the association between the a5 subunit nicotinic acetylcholine receptor single nucleotide polymorphism and lung cancer may, in part, be confounded by chronic obstructive pulmonary disease.

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Does lobectomy for lung cancer in patients with chronic obstructive pulmonary disease affect lung function? A multicenter national study

Abstract: Patients with mild to severe chronic obstructive pulmonary disease could have a better late preservation of pulmonary function after lobectomy than healthy patients.

Cited by 81 publications

References 21 publications

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Pulmonary Function Changes Over 1 Year After Lobectomy in Lung Cancer

Lung cancer gene associated with COPD: triple whammy or possible confounding effect?

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