Lung cancer as a risk factor for abdominal aortic aneurysm

Abstract

Background Lung cancer and abdominal aortic aneurysm (AAA) have several common risk factors. Considering that AAA is fatal, precise diagnosis and management of AAA would result in long-term survival benefit in patients with early lung cancer with good prognosis. We aimed to assess the prevalence and characteristics of AAA in patients with resectable non-small cell lung cancer (NSCLC). Methods Between January 2019 and November 2020, 1,019 patients with primary NSCLC treated surgically in Severance and Kangbuk Samsung Hospitals were reviewed retrospectively. We re-read abdominal-pelvic computed tomography (APCT) and positron emission tomography (PET) images and evaluated the presence of AAA. The control group comprised 2,899 cancer-free people who had a health check-up CT scan in Severance between January 2018 and December 2019. The Institutional Review Board and Ethics Committee of Severance Hospital approved this study (IRB number: 4–2021–1430). Results Among patients with resectable primary NSCLC patients, 39/1,019 (3.8%; odds ratio [OR], 19.19; 95% confidence interval [CI], 8.10–46.46) had AAA compared with 6/2,899 (0.2%) in the control (P < 0.001). Smokers were more likely to have AAA than non-smokers (7.0% vs 0.8%; OR, 9.57; 95% CI, 3.38–27.14; P < 0.001). In multivariable regression analysis, male sex (OR, 13.24; 95% CI, 1.50–117.48; P = 0.020), older age (OR, 1.10; 95% CI, 1.04–1.15; P < 0.001), current smoker status (OR, 4.20; 95% CI, 1.20–14.62; P = 0.024), and coronary artery obstructive disease (OR, 3.13; 95% CI, 1.48–6.62; P = 0.003) were independent risk factors for AAA development in lung cancer. Conclusions In our real-world study, patients with early lung cancer has a significantly higher prevalence of AAA than cancer-free controls, indicating they are a high-risk group for AAA. Therefore, we suggest patients with early NSCLC, especially smokers older than 60 years, undergo regular AAA surveillance with long term post-op follow-up for not only lung cancer but also AAA.