Quantitative CT Assessment of Emphysema and Airways in Relation to Lung Cancer Risk

Gierada, David S.; Guniganti, Preethi; Newman, Blake J.; Kvale, Paul A.; Lynch, David A.; Pilgram, Thomas K.

doi:10.1148/radiol.11110542

Cited by 58 publications

(46 citation statements)

References 35 publications

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“…Although associated with an increased risk of lung cancer in some studies, the overall role of emphysema as a risk factor for lung cancer is still under investigation (22)(23)(24)(25)(26)(27)(28)(29). However, risk factors for incident lung cancer and those related to prognosis are not necessarily the same (e.g., radon exposure).…”

Section: Original Researchmentioning

confidence: 99%

Regional Emphysema of a Non-Small Cell Tumor Is Associated with Larger Tumors and Decreased Survival

Kinsey¹,

Estépar²,

Wei

et al. 2015

Annals ATS

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Rationale: Chronic obstructive pulmonary disease is associated with a worse overall survival in non-small cell lung cancer. Lung emphysema is one component of chronic obstructive pulmonary disease. We hypothesized that emphysema of the tumor region may result in larger tumors and a poorer overall survival. Methods:We evaluated 304 cases of non-small cell lung cancer from a prospectively enrolled cohort. The lung was divided into equal volumetric thirds (upper, middle, or lower region). Emphysema was defined as percentage of low-attenuation areas less than 2950 Hounsfield units (%LAA2950) and measured for each region. Wholelung %LAA2950 was defined as the emphysema score of the entire lung parenchyma, whereas regional %LAA2950 was the score within that particular region (upper, middle, or lower). The emphysema score of the region in which the tumor occurred was defined as the tumor %LAA2950. Tumor diameter was measured while blinded to characteristics of the lung parenchyma. A proportional hazards model was used to control for multiple factors associated with survival.Measurements and Main Results: Increasing tumor %LAA2950 was associated with larger tumors (P = 0.024). Survival, stratified by stage, was significantly worse in those with tumor %LAA2950 greater than or equal to the 50th percentile versus less than the 50th percentile (P = 0.046). Whole-lung %LAA2950 and regional %LAA2950 (e.g., regional emphysema without tumor occurring in the region) were not significantly associated with survival. There were no differences in presenting symptoms or locations of mediastinal or distant metastasis by emphysema score. Increasing tumor %LAA2950 was associated with an increased risk of death (adjusted hazard ratio, 1.36; confidence interval, 1.09-1.68; P = 0.006) after adjustment for age, sex, smoking status, histology, stage, performance status, chemotherapy, radiation, and surgery. Sensitivity analyses revealed no significant difference in the effect size or test of significance for each of the following conditions: (1) exclusion of cases with central tumor location, (2) exclusion of cases where surgery was performed, (3) exclusion of cases where radiation therapy was performed, (4) exclusion of cases where epidermal growth factor receptor tyrosine kinase inhibitors were administered, and (5) inclusion of only stage IV disease.Conclusions: Increasing emphysema of the region in which a nonsmall cell lung cancer tumor occurs is associated with increasing tumor size and worse overall survival.

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Section: Original Researchmentioning

confidence: 99%

Regional Emphysema of a Non-Small Cell Tumor Is Associated with Larger Tumors and Decreased Survival

Kinsey¹,

Estépar²,

Wei

et al. 2015

Annals ATS

View full text Add to dashboard Cite

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“…By contrast, MALDONADO et al [24] reported that the radiographic evidence for emphysema, evaluated by automated quantitative computed tomography analysis, was not a significant risk for lung cancer (OR 1.042, 95% CI 0.816-1.329) and emphysema severity was also not associated with lung cancer (OR 1.57, 95% CI 0. 73-3.37 [26] reported that not only emphysema but also bronchial measurements at segmental-subsegmental levels, as assessed by automated computed tomography analysis, were not also associated with lung cancer. WILSON et al [27] reported that their casecontrol study of 117 lung cancer cases did not reveal any evidence that either airway obstruction or emphysema, as assessed by quantitative analysis of computed tomography images, was associated with increased risk of lung cancer.…”

Section: Epidemiology and Risk Of Lung Cancer In Copd Patientsmentioning

confidence: 99%

Early detection of COPD is important for lung cancer surveillance

Sekine¹,

Katsura²,

Koh³

et al. 2011

Eur Respir J

123

101

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It is well known that chronic obstructive pulmonary disease (COPD) is a significant risk factor for lung cancer. Approximately 1% of COPD patients develop lung cancer every year, which may be associated with genetic susceptibility to cigarette smoke. Chronic inflammation caused by toxic gases can induce COPD and lung cancer. Inflammatory mediators may promote the growth of bronchioalveolar stem cells, and activation of nuclear factor-kB and signal transducer and activator of transcription 3 play crucial roles in the development of lung cancer from COPD.Low-dose computed tomography (LDCT) is an effective procedure for the early detection of lung cancer in high-risk patients. However, determining which patients should be screened for lung cancer in a primary care setting is difficult. In this article, we review the epidemiology and aetiology of lung cancer associated with COPD, verify the efficacy of lung cancer screening by LDCT, and discuss the importance of early detection of COPD for lung cancer surveillance.We propose that, for the prevention of both diseases, COPD screening in smokers should be initiated as early as possible, so they can stop smoking and so that candidates for an efficient lung cancer screening programme can be identified.

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“…Conversely, no association between emphysema features as assessed by automated CT analysis and lung cancer was observed.Our findings are not only in keeping with previous studies reporting no association between whole-lung emphysema extent as quantified by automated CT analysis and lung cancer, but also expand on this by including a number of cases recruited outside the screening context. 2,[8][9][10] The inclusion of such cases provides a more representative picture of the disease, owing to the inclusion of a higher proportion of tumours at advanced stages. Nevertheless, the lack of association between whole-lung emphysema extent and lung cancer was maintained for both screening and non-screening detected cases.…”

Section: Discussionmentioning

confidence: 99%

“…2,[8][9][10] In addition, two studies recently reported no association between automated CT measures of proximal (segmental and subsegmental) airway disease and lung cancer. 9,10 However, previous studies did only include subjects with lung cancer detected in a screening setting and the emphysema phenotype as well as MLD were not fully assessed. 2,5,6,[8][9][10] There is evidence that screening-detected lung cancers may differ from the general pool of lung cancers in their morphology, histology, and prognosis.…”

Section: Introductionmentioning

confidence: 99%

“…9,10 However, previous studies did only include subjects with lung cancer detected in a screening setting and the emphysema phenotype as well as MLD were not fully assessed. 2,5,6,[8][9][10] There is evidence that screening-detected lung cancers may differ from the general pool of lung cancers in their morphology, histology, and prognosis. 11,12 Likewise, emphysema in screening participants may be different from that of outpatients with lung cancer.…”

Section: Introductionmentioning

confidence: 99%

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