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Association of Radiographic Emphysema and Airflow Obstruction with Lung Cancer

¹ Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, and ² Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; ³ Gulhane Military Medical Academy, Department of Pulmonary Medicine, Ankara, Turkey; ⁴ Department of Radiology, ⁵ Heart, Lung, Esophageal Surgery Institute, and ⁶ Department of Pharmacology, University of Pittsburgh, Pittsburgh, Pennsylvania

Correspondence and requests for reprints should be addressed to David O. Wilson, M.D., M.P.H., UPMC-Shadyside Place, 580 S. Aiken Avenue, Suite 400, Pittsburgh, PA 15232. E-mail: wilsondo{at}upmc.edu

Rationale: To study the relationship between emphysema and/or airflow obstruction and lung cancer in a high-risk population.

Objective: We studied lung cancer related to radiographic emphysema and spirometric airflow obstruction in tobacco-exposed persons who were screened for lung cancer using chest computed tomography (CT).

Methods: Subjects completed questionnaires, spirometry, and low-dose helical chest CT. CT scans were scored for emphysema based on National Emphysema Treatment Trial criteria. Multiple logistic regressions estimated the independent associations between various factors, including radiographic emphysema and airflow obstruction, and subsequent lung cancer diagnosis.

Measurements and Main Results: Among 3,638 subjects, 57.5, 18.8, 14.6, and 9.1% had no, trace, mild, and moderate–severe emphysema, and 57.3, 13.6, 22.8, and 6.4% had no, mild (Global Initiative for Chronic Obstructive Lung Disease [GOLD] I), moderate (GOLD II), and severe (GOLD III–IV) airflow obstruction. Of 3,638 subjects, 99 (2.7%) received a lung cancer diagnosis. Adjusting for sex, age, years of cigarette smoking, and number of cigarettes smoked daily, logistic regression showed the expected lung cancer association with the presence of airflow obstruction (GOLD I–IV, odds ratio [OR], 2.09; 95% confidence interval [CI], 1.33–3.27). A second logistic regression showed lung cancer related to emphysema (OR, 3.56; 95% CI, 2.21–5.73). After additional adjustments for GOLD class, emphysema remained a strong and statistically significant factor related to lung cancer (OR, 3.14; 95% CI, 1.91–5.15).

Conclusions: Emphysema on CT scan and airflow obstruction on spirometry are related to lung cancer in a high-risk population. Emphysema is independently related to lung cancer. Both radiographic emphysema and airflow obstruction should be considered when assessing lung cancer risk.

Key Words: emphysema • chronic obstructive pulmonary disease • lung cancer

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Several studies imply a relationship between chronic obstructive pulmonary disease (airflow obstruction) and lung cancer, but very limited information about emphysema and lung cancer risk exists in the literature. What This Study Adds to the Field Emphysema is independently related to lung cancer. Both radiographic emphysema and airflow obstruction should be considered when assessing lung cancer risk.

 

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