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

de-Torres, Juan P.; Bastarrika, Gorka; Wisnivesky, Juan P.; Alcaide, Ana B.; Campo, Arantza; Seijó, Luis; Pueyo, Jesús C.; Villanueva, Alberto; Lozano, Marı́a D.; Montes, Usua; Montuenga, Luis M.; Zulueta, Javier J.

doi:10.1378/chest.07-1490

Cited by 399 publications

(333 citation statements)

References 28 publications

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“…Thus, QCT and visual evaluation may provide complementary, independent assessments of severity of emphysema, particularly in those with less severe abnormality. Interestingly, although the presence of emphysema on visual assessment is associated with lung cancer, 62,63 quantitative CT measurement of emphysema has not been shown to be independently associated with lung cancer.…”

Section: Concordance Between Qct and Visual Evaluationmentioning

confidence: 96%

Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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Abbreviations: computed tomography, CT; magnetic resonance imaging, MRI; positron emission tomography, PET; Global Initiative for chronic Obstructive Lung Disease, GOLD; quantitative CT, QCT; Hounsfield Units, HU; percentage of low attenuation area, %LAA; relative area of lung less than -950 HU, RA950; Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints, ECLIPSE; forced expiratory volume in 1 second, FEV1; forced vital capacity, FVC. Journal of the COPD Foundation(GOLD) stage may have substantial, little, or no emphysema. Discrete subphenotypes of COPD include emphysema of varying morphologic appearance, large airway abnormality and small airway obstruction. Increasing awareness of the heterogeneity of COPD has led to increased use of CT to characterize COPD for purposes of genetic evaluation and identification of specific subgroups which may be amenable to therapeutic trials. 1-3 While visual assessment is important in determining the presence and character of emphysema, the last decade has been characterized by increasing use of quantitative imaging to provide precise estimates of the severity and distribution of emphysema, gas trapping and airway wall thickening. Several large cohorts of cigarette smokers have now been quite extensively characterized by CT, resulting in increased knowledge of the clinical correlates of quantitative CT parameters. [4][5][6] The purpose of this paper is to present the substantial contribution that imaging has made to our understanding of COPD over the past 10 years. AbstractComputed tomography (CT) has contributed substantially to our understanding of COPD over the past decade. Visual and quantitative assessments of CT in COPD are complementary. Visual assessment should provide assessment of centrilobular, panlobular and paraseptal emphysema, airway wall thickening, bronchiectasis, findings of respiratory bronchiolitis, and enlargement of the pulmonary artery. Quantitative CT permits evaluation of severity of emphysema, airway wall thickening, and expiratory air trapping, and is now being used for longitudinal evaluation of the progression of COPD. Innovative techniques are being developed to use CT to characterize the pattern of emphysema and smoking-related respiratory bronchiolitis. Magnetic resonance imaging (MRI) and positron emission tomography PET-CT are useful research tools in the evaluation of COPD.

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Section: Concordance Between Qct and Visual Evaluationmentioning

confidence: 96%

Progress in Imaging COPD, 2004 - 2014

Lynch¹

2014

J COPD F

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“…These studies suggest that impaired lung function (based on reduced FEV1) is more important than age or smoking exposure (measured as pack-yrs) [15,27]. In a small CT screening study from Spain, the vast majority of lung cancer cases (20 (87%) out of 23) had either spirometric evidence of COPD (16 (69%) out of 23 with GOLD 1+) or radiological evidence of emphysema of variable severity (17 (74%) out of 23) [28]. Furthermore, mortality studies of patients with COPD suggest 20-30% die from lung cancer [29].…”

Section: Thoracic Oncology Rp Young Et Almentioning

confidence: 99%

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

Young¹,

Hopkins²,

Christmas³

et al. 2009

Eur Respir J

579

493

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Chronic obstructive pulmonary disease (COPD) is a common comorbid disease in lung cancer, estimated to affect 40-70% of lung cancer patients, depending on diagnostic criteria. As smoking exposure is found in 85-90% of those diagnosed with either COPD or lung cancer, coexisting disease could merely reflect a shared smoking exposure. Potential confounding by age, sex and pack-yr smoking history, and/or by the possible effects of lung cancer on spirometry, may result in over-diagnosis of COPD prevalence.In the present study, the prevalence of COPD (pre-bronchodilator Global Initiative for Chronic Obstructive Lung Disease 2+ criteria) in patients diagnosed with lung cancer was 50% compared with 8% in a randomly recruited community control group, matched for age, sex and pack-yr smoking exposure (n5602, odds ratio 11.6; p,0.0001).In a subgroup analysis of those with lung cancer and lung function measured prior to the diagnosis of lung cancer (n5127), we found a nonsignificant increase in COPD prevalence following diagnosis (56-61%; p50.45). After controlling for important variables, the prevalence of COPD in newly diagnosed lung cancer cases was six-fold greater than in matched smokers; this is much greater than previously reported.We conclude that COPD is both a common and important independent risk factor for lung cancer.KEYWORDS: Chronic obstructive pulmonary disease, epidemiology, lung cancer, risk, spirometry A s only 10-15% of chronic smokers get lung cancer [1], host susceptibility factors have been implicated. Age, smoking history, family history and impaired lung function have been identified as key risk factors [2]. The question that then arises is: does the association between chronic obstructive pulmonary disease (COPD) and lung cancer come down to more than a shared smoking history?Cross-sectional studies show that the prevalence of COPD is 40-70% of those diagnosed with lung cancer [3,4], although prevalence is highly dependent on diagnostic criteria, age, sex and smoking exposure [5]. As none of these studies compared the prevalence of COPD in their lung cancer cohorts with a smoking cohort matched for these variables, the significance of this finding is uncertain. Moreover, none of these studies considered that lung cancer may itself cause an obstructive effect on spirometry. It is possible that potential confounding by age, sex and packyr smoking history on COPD prevalence, and/or the possible effects of lung cancer per se on spirometry, could result in over-diagnosis of COPD and a falsely increased association between COPD and lung cancer.

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“…Lung cancer is highly heterogeneous genetically because of a high mutation rate, as well as extremely complex since it comprises a disparate subset of diseases with distinct and possibly overlapping pathobiologies that share a common phenotypic manifestation. Smoking is a core shared risk factor for COPD and lung cancer; up to 65-70% of lung cancer patients suffer both lung cancer and COPD [102,103]. So far, no single satisfactory circulating (i.e.…”

Section: Lung Cancermentioning

confidence: 99%

From systems biology to P4 medicine: applications in respiratory medicine

2018

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Human health and disease are emergent properties of a complex, nonlinear, dynamic multilevel biological system: the human body. Systems biology is a comprehensive research strategy that has the potential to understand these emergent properties holistically. It stems from advancements in medical diagnostics, "omics" data and bioinformatic computing power. It paves the way forward towards "P4 medicine" ( predictive, preventive, personalised and participatory), which seeks to better intervene preventively to preserve health or therapeutically to cure diseases. In this review, we: 1) discuss the principles of systems biology; 2) elaborate on how P4 medicine has the potential to shift healthcare from reactive medicine (treatment of illness) to predict and prevent illness, in a revolution that will be personalised in nature, probabilistic in essence and participatory driven; 3) review the current state of the art of network (systems) medicine in three prevalent respiratory diseases (chronic obstructive pulmonary disease, asthma and lung cancer); and 4) outline current challenges and future goals in the field.

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

Cited by 399 publications

References 28 publications

Progress in Imaging COPD, 2004 - 2014

Progress in Imaging COPD, 2004 - 2014

COPD prevalence is increased in lung cancer, independent of age, sex and smoking history

From systems biology to P4 medicine: applications in respiratory medicine

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