Published ahead of print on June 19, 2008, doi:10.1164/rccm.200803-435OC
Am. J. Respir. Crit. Care Med., Volume 178, Number 7, October 2008, 738-744
A more recent version of this article appeared on October 1, 2008
Submitted on March 19, 2008
Accepted on June 18, 2008
Association of Radiographic Emphysema and Airflow Obstruction with Lung Cancer
David O Wilson1*, Joel L Weissfeld2, Arzu Balkan3, Jeffrey G Schragin2, Carl R Fuhrman4, Stephen N Fisher4, Jonathan Wilson5, Joseph K Leader4, Jill Siegfried6, Steven D Shapiro1, and Frank C Sciurba1
1 Department of Medicine, University of Pittsburgh, Division of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA,
2 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA,
3 Department of Medicine, University of Pittsburgh, Division of Pulmonary Allergy and Critical Care Medicine, Pittsburgh, PA, USA; Department of Pulmonary Medicine, Gulhane Military Medical Academy, Ankara, Turkey,
4 Department of Radiology, University of Pittsburgh, Pittsburgh, PA, USA,
5 Heart, Lung, Esophageal Surgery Institute, University of Pittsburgh, Pittsburgh, PA, USA,
6 Department of Pharmacology, University of Pittsburgh, Pittsburgh, PA, USA
* To whom correspondence should be addressed. E-mail: wilsondo{at}upmc.edu.
Objective: We studied lung cancer related to radiographic emphysema and spirometric airflow obstruction in tobacco-exposed persons screened for lung cancer with 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 (NETT) criteria. Multiple logistic regressions estimated the independent associations between various factors, including radiographic emphysema and airflow obstruction, and subsequent lung cancer diagnosis.
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. Ninety-nine (99, 2.7% subjects of 3,638) received a lung cancer diagnosis. Adjusting for gender, age, years of cigarette smoking, and number of cigarettes smoked daily, logistic regression showed the expected lung cancer association with 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, any emphysema remained a strong and statistically significant factor related to lung cancer (OR 3.14, 95% CI 1.91 - 5.15).
Conclusion: 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, COPD, lung cancer risk
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