Computed Tomography–Diagnosed Emphysema, Not Airway Obstruction, Is Associated with the Prognostic Outcome of Early-Stage Lung Cancer

Abstract

Purpose: Because both emphysema and lung cancer can arise from biological damage caused by cigarette smoking, we investigated if the development of emphysema is associated with the clinical features of smoker's lung cancer. Experimental Design: The subjects were a consecutive series of 100 smokers who underwent lobectomy with hilar and mediastinal dissection for clinical stage I non^small cell lung cancer. We studied the relationship between the presence or absence of emphysema at the onset of the lung cancer and clinicopathologic features. Emphysema was diagnosed by measuring the lowattenuation area using computed tomography densitometry. Results: There were no differences in clinicopathologic variables, including the degree of smoking exposure between the patients with (n = 58) and those without (n = 42) emphysema, although male gender and airflow limitation were predominant in the patients with emphysema. The presence of emphysema, but neither male gender nor airflow limitation, adversely affected both overall and disease-specific survival. According to Cox regression analysis, emphysema was an independent prognosticator among age, gender, degree of smoking exposure, tumor size, nodal status, histologic subtype, histologic grade, and microvessel invasion. These results were stabilized by a bootstrap sampling model. Conclusions: Computed tomography^diagnosed emphysema, but not airway obstruction, is associated with poor prognosis in smokers with early-stage lung cancer. Thus, routine computed tomography densitometry in smokers with lung cancer should be mandatory.

Prognostic significance of CT-emphysema score in patients with advanced squamous cell lung cancer

“…This finding is consistent with previous studies, which also found COPD had no prognostic impact in patients with earlystage NSCLC or in patients with advanced NSCLC that received chemotherapy (10,19). In addition, the severity of emphysema in the present study was not well correlated with FEV 1 (%), which was also reported by Ueda et al (10).…”

“…Scores of the six regions were summed to obtain total scores, giving a minimum total score of 0 and a maximum of 24. Total CT-emphysema scores of 0 or 1 were defined as no emphysema, since 95% of nonsmokers in previous series had lungs with <5% emphysematous involvement (10).…”

“…Computed tomography (CT) is an established method for the detection and quantification of emphysema (6,7), and CT-diagnosed emphysema has also been reported to be associated with an increased risk of lung cancer independently of smoking history and airflow obstruction (8). Furthermore, recent studies have reported that presence of emphysema detected by CT in resected Original Article Prognostic significance of CT-emphysema score in patients with advanced squamous cell lung cancer and in all stages of non-small cell lung cancer (NSCLC) patients has an adverse prognostic impact (9,10).…”

A lower level of forced expiratory volume in one second predicts the poor prognosis of small cell lung cancer

“…The airway obstruction and treatment response of lung cancer is controversial. In early-stage lung cancer, emphysema, not airway obstruction, is associated with poor prognostic outcomes (9). But, the combination of COPD and cancer stage, age, gender and tumor grade improves the prediction of treatment response in NSCLC (10).…”

Frequency of Epidermal Growth Factor Receptor Mutation in Smokers with Lung Cancer Without Pulmonary Emphysema

“…Regardless of cumulative smoking dose, patients with chronic airflow obstruction have a greater risk for lung cancer (18,19). In recent studies addressing the association between emphysema and lung cancer, the presence of emphysema detected using chest computed tomography (CT) in smokers is reported to be an important risk factor for lung cancer and poor prognosis (20)(21)(22)(23)(24)(25). Thus, we hypothesized that genetic abnormality, including driver mutations, in lung cancer may differ according to the presence or absence of emphysema even in patients with the same histological type of cancer.…”