Risk of Lung Cancer Associated with COPD Phenotype Based on Quantitative Image Analysis

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a risk factor for lung cancer. This study evaluates alternative measures of COPD based on spirometry and quantitative image analysis to better define a phenotype that predicts lung cancer risk. Methods Three-hundred-forty-one lung cancer cases and 752 volunteer controls age 21–89 years participated in a structured interview, standardized CT scan and spirometry. Logistic regression, adjusted for age, race, gender, pack-years, and inspiratory and expiratory total lung volume, was used to estimate the odds of lung cancer associated with FEV1/FVC, percent voxels less than -950 Hounsfield Units on the inspiratory scan (HUI) and percent voxels less than -856 HU on expiratory scan (HUE). Results The odds of lung cancer were increased 1.4- to 3.1-fold among those with COPD compared to those without, regardless of assessment method, however, in multivariable modeling, only percent voxels < -856 HUE as a continuous measure of air trapping (OR=1.04; 95% CI (1.03, 1.06)) and FEV1/FVC < 0.70 (OR=1.71; 95% CI (1.21, 2.41)) were independent predictors of lung cancer risk. Nearly 10% of lung cancer cases were negative on all objective measures of COPD. Conclusion Measures of air trapping using quantitative imaging, in addition to FEV1/FVC, can identify individuals at high risk of lung cancer and should be considered as supplemental measures at the time of screening for lung cancer. Impact Quantitative measures of air trapping based on imaging provide additional information for the identification of high risk groups who might benefit the most from lung cancer screening.

The link between chronic obstructive pulmonary disease phenotypes and histological subtypes of lung cancer: a case&ndash;control study

“…Besides, in this study, the same relationships were also observed in nonsmokers and female subgroups, and were consistent with the results reported by two specific population studies. 40 , 42 The results were not in line with another study conducted in southern China in that they reported no significant relationship between previous COPD (including COPD, emphysema and chronic bronchitis) and the risk of lung cancer in nonsmokers. 43 This requires a larger multicenter study to verify.…”

“…Moreover, certain studies were performed only on smokers. 19 , 21 , 40 Our lung cancer cases were not specifically selected (such as targeting population at higher risk). During subgroup analysis, we found that the prevalence of COPD in lung cancer cases was 42.4% in smokers compared to 21.8% in nonsmokers (data not shown).…”

Quantitative Imaging Markers of Lung Function in a Smoking Population Distinguish COPD Subgroups with Differential Lung Cancer Risk

“…The INHALE study was initiated in 2012 and has been described previously (10). Briefly, lung cancer cases were enrolled at the Karmanos Cancer Institute (Detroit, MI) or Henry Ford Health System (HFHS, Detroit, MI) within 12 months of diagnosis.…”

“…Quantitative imaging based on low-dose chest CT scans allows objective measurement of radiologic features of COPD, and the regional distribution of COPD gained from quantitative CT (qCT) measures have been shown to provide additional clinically relevant information beyond spirometry. qCT whole lung measures of emphysema and air trapping are correlated with measures of lung function from spirometry, even in presymptomatic individuals, and predict risk of lung cancer (5)(6)(7)(8)(9)(10).…”

Lung cancer in chronic obstructive pulmonary disease patients. Does cellular senescence matter?

“…Emphysema is associated with in creased risk of lung cancer in individuals without airflow obstruction on spirometry, as well as those with coexistent airway obstruction and emphy sema. 12,13 The results of multiple analyses inves tigating the link between COPD and lung cancer also differ depending on the type of study, from lung cancer screening trials to population based and case control studies. 14,15 The causative role of COPD in lung cancer is supported by the find ing that 40% to 70% of patients with lung can cer had clinically confirmed COPD that devel oped prior to cancer.…”