The correlation of emphysema or airway obstruction with the risk of lung cancer: a matched case-controlled study

Kishi, Koji; Gurney, Jud W.; Schroeder, Darrell R.; Scanlon, Paul D.; Swensen, Stephen J.; Jett, James R.

doi:10.1183/09031936.02.00264202

Cited by 90 publications

(72 citation statements)

References 32 publications

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“…[15][16][17]21 Additionally, a recent study 22 has found that emphysema detected on CT, and not airway obstruction, was associated with a worse prognosis in smokers with early stage lung cancer. Conversely, a case-controlled study 23 using data from subjects enrolled in the Mayo Clinic LDCT early lung cancer detection study found that severe airway obstruction, but not emphysema, was associated with a higher risk of lung cancer. The discrepancy in the results between this study and ours may be explained by several reasons.…”

Section: Discussionmentioning

confidence: 99%

Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the Chest

de-Torres

Bastarrika

Wisnivesky

et al. 2007

Chest

396

303

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Rationale: Identification of risk factors for lung cancer can help in selecting patients who may benefit the most from smoking cessation interventions, early detection, or chemoprevention. Objective: To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer. Methods: The study used data from a prospective cohort of 1,166 former and current smokers participating in a lung cancer screening study. All individuals underwent a baseline LDCT and spirometry followed by yearly repeat LDCT studies. The incidence density of lung cancer among patients with and without emphysema on LDCT was estimated. Stratified and multiple regression analyses were used to assess whether emphysema is an independent risk factor for lung cancer after adjusting for age, gender, smoking history, and the presence of airway obstruction on spirometry. Abbreviations: CI ϭ confidence interval; IQR ϭ interquartile range; LDCT ϭ low-radiation-dose CT; RR ϭ risk ratio L ung cancer is the deadliest malignancy in the world among men and women.

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Section: Discussionmentioning

confidence: 99%

Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the Chest

de-Torres

Bastarrika

Wisnivesky

et al. 2007

Chest

396

303

View full text Add to dashboard Cite

show abstract

“…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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“…However, it is unclear whether the presence of airflow obstruction constitutes a significant risk factor for development of lung cancer, independently from smoking [2].…”

mentioning

confidence: 99%

Lung function predicts lung cancer risk in smokers: a tool for targeting screening programmes

Calabrò¹,

Randi²,

Vecchia³

et al. 2009

European Respiratory Journal

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ABSTRACT:The relationship between smoking, lung cancer and airflow obstruction is recognised but it is unclear whether the presence of minimal lung function damage constitutes an independent risk factor for the development of lung cancer.In order to identify those individuals at higher risk of lung cancer on the basis of functional impairment, we evaluated baseline pulmonary function tests of 3,806 heavy smokers undergoing annual chest computed tomography screening, and compared the forced expiratory volume in 1 s (FEV1) % predicted of 57 lung cancer cases and that of 3,749 subjects without cancer.We obtained odds ratios (ORs) of lung cancer and the corresponding 95% confidence intervals (CIs) using unconditional logistic regression, adjusting for age, sex, study and smoking variables. Compared with subjects with FEV1 o90% pred, the OR of lung cancer was 2.45 (95% CI 1.39-4.33) for subjects with FEV1 ,90% pred and 2.90 (95% CI 1.34-6.27) for subjects with FEV1 ,70% pred.These data show that even a relatively small reduction in FEV1 % pred is a significant predictor of increased lung cancer risk. Test screening for lung cancer using airflow obstruction with FEV1 ,90% is a strategy worth future consideration.

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The correlation of emphysema or airway obstruction with the risk of lung cancer: a matched case-controlled study

Cited by 90 publications

References 32 publications

Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the Chest

Assessing the Relationship Between Lung Cancer Risk and Emphysema Detected on Low-Dose CT of the Chest

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

Lung function predicts lung cancer risk in smokers: a tool for targeting screening programmes

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