Influence of the type of emphysema in the relationship between COPD and lung cancer

Abstract

IntroductionThere are no studies analyzing the relationship between emphysema and lung cancer (LC). With this aim and in order to make some comparisons between different clinical variables, we carried out the present study.MethodsThis is a case–control study, patients with COPD and LC being the cases and subjects with stable COPD being the controls. Clinical and functional parameters, as well as the existence of radiological emphysema, were evaluated in a qualitative and quantitative way, using a radiological density of −950 Hounsfield units as a cutoff point in the images. The existence of several different types of emphysema (centrilobular, paraseptal, panacinar, or bullae) was analyzed, allowing patients to have more than one simultaneously. The extent to which lobes were involved was evaluated and the extension of emphysema was graduated for each type and location, following a quantitative scale. Differences between cases and controls were compared by using bivariate and multivariate analyzes with results expressed as OR and 95% CI.ResultsWe included 169 cases and 74 controls, 84% men with a FEV1 (%) of 61.7±18.5, with 90.1% non-exacerbators. Most of them (50%) were active smokers and 47.2% were ex-smokers. Emphysema was found in 80.2% of the subjects, the most frequent type being centrilobular (34.4%). The only significantly different factor was the presence of paraseptal emphysema (alone or combined; OR =2.2 [95% CI =1.1–4.3, P = 0.03]), with adenocarcinoma being significantly more frequent in paraseptal emphysema with respect to other types (67.2% vs 32.8%, P =0.03).ConclusionPatients with COPD and paraseptal emphysema could be a risk group for the development of LC, especially adenocarcinoma subtype.

Discordant Quantitative and Visual CT Assessments in the Diagnosis of Emphysema

“…Furthermore, visual emphysema assessment has the relative advantage of identifying paraseptal emphysema and distinguishing it from centrilobular emphysema, as presence of the former might have clinical implications. Historically thought to be of uncertain clinical significance, 21 , 22 paraseptal emphysema has been associated with substantial disease progression, 15 interstitial lung abnormalities, 23 and adenocarcinoma of the lung 24 although the possibility of a confounding effect of co-existing centrilobular emphysema needs to be considered. 15 …”

Lung emphysema and lung cancer: what do we know about it?

“…Shin et al (51) studied histological type in peripherally localised LC in 230 patients [2013][2014][2015] with CT-detected pulmonary emphysema and airflow obstruction, among whom the most frequent histological type in peripheral areas without emphysema was adenocarcinoma (58%), whilst in areas with emphysema it was small cell carcinoma (61%) after adjustment for age, sex, smoking habit and FEV1. In Mouronte-Roibás et al's study (38), the most frequent histology associated with presence of paraseptal emphysema was adenocarcinoma (67.2%), as was the case in González et al's study (39), with an adenocarcinoma frequency of 50%. Wang et al's (40) found an association between the emphysema phenotype and the squamous (OR =1.73; 95% CI, 1.03-2.89) and small cell (OR =3.74; 95% CI, 1.64-8.53) lineages.…”

“…Mouronte-Roibás et al (38) analysed the relationship between type of emphysema and risk of LC in a study that included 169 cases of LC and COPD plus 74 controls, they found that presence of paraseptal emphysema and COPD increased the risk of LC (OR =2.17; 95% CI, 1.09-4.30; P=0.03). In contrast, in a sample of 72 consecutive LC cases sourced from the Navarre University LC screening programme (Spain) with 3,477 participants, González et al (39) detected that risk of LC was associated with presence of airflow obstruction (OR =2.8; 95% CI, 1.6-5.2) and centrilobular emphysema (OR =34.3; 95% CI, 25.5-99.3), and that this risk decreased when associated with paraseptal emphysema (OR =4; 95% CI, 3.6-34.9).…”

Objective quantitative multidetector computed tomography assessments in patients with combined pulmonary fibrosis with emphysema: Relationship with pulmonary function and clinical events

“…Emphysema subtypes are divided into three types; centrilobular, paraseptal, and panlobular [ 24 ]. Centrilobular emphysema is commonly complicated by COPD [ 25 ], and emphysema subtypes in COPD are related to pulmonary symptoms, the development of lung cancer, and worsening radiological findings [ 26 , 27 ]. In contrast, CPFE patients are likely to exhibit paraseptal emphysema (30%-65%) [ 28 , 29 ], which is consistent with the present study.…”