Effect of Emphysema on Lung Cancer Risk in Smokers: A Computed Tomography–Based Assessment

Li, Yan; Swensen, Stephen J.; Karabekmez, Leman Günbey; Marks, Randolph S.; Stoddard, Shawn M.; Jiang, Ruoxiang; Worra, Joel B.; Zhang, Fang; Midthun, David E.; Andrade, Mariza de; Song, Yong; Yang, Ping

doi:10.1158/1940-6207.capr-10-0151

Cited by 90 publications

(77 citation statements)

References 38 publications

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“…However, the advantage in our study is that visual assessment does not require additional software and is simple, and previous studies have shown the validity of this approach. [19][20][21][22] In conclusion, emphysema frequently is present on chest CT scans of smokers and predicts early death from COPD or lung cancer. These data provide strong evidence regarding the validity and utility of these studies, one-half of the participants with emphysema (15% of the entire cohort) had normal lung function, and the presence of emphysema was found to predict a diagnosis of lung cancer even among patients with normal spirometry.…”

Section: Resultsmentioning

confidence: 89%

Emphysema Scores Predict Death From COPD and Lung Cancer

Zulueta

Wisnivesky

Henschke

et al. 2012

Chest

149

106

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COPD is the fourth leading cause of death in the United States and causes . 2.5 million deaths worldwide each year. [1][2][3] The most frequent cause of death in advanced COPD is respiratory failure, but in mild and moderate COPD, lung cancer and cardiovascular diseases account for two-thirds of the deaths. 4 GOLD (Global Initiative for Chronic Obstructive Lung Disease) defi nes COPD as a disease state characterized by the presence of airway obstruction that is not fully reversible. 5 In these patients, airfl ow obstruction is caused by a mixture of small airways disease (obstructive bronchiolitis) and parenchymal destruction (emphysema); the relative contributions vary from person to person. Airway obstruction, readily determined by spirometry, has been shown to predict an increased mortality rate in the general population. 6 Emphysema has been extensively studied physiologically, pathologically, and at autopsy, but not until recent advances in CT scan technology has there been a reliable means for its in vivo diagnosis and characterization. However, data regarding the signifi cance of CT scan-detected emphysema in deter mining outcomes are scarce. Studies have shown that the presence of emphysema on low-dose chest CT scan in a cohort participating in a lung cancer screening study is an independent risk factor for lung cancer. 7,8 A study that was limited to patients with lung cancer showed that CT scan-detected emphysema, but not airway obstruction, was associated with a worse prognosis. 9 Recently, the presence of emphysema on a CT scan has been associated with an increase in mortality in a small cohort of patients with COPD, most of whom entered the study in advanced stages of the disease. 10 To date, no relationship between emphysema as identifi ed on chest CT scan and mortality in the general population or in asymptomatic smokers has been reported. In the present study, we explored whether the presence and extent of emphysema detected on low-dose CT scans are risk factors for mortality from COPD or lung cancer among a large cohort of asymptomatic smokers.Objective: Our objective was to assess the usefulness of emphysema scores in predicting death from COPD and lung cancer. Methods: Emphysema was assessed with low-dose CT scans performed on 9,047 men and women for whom age and smoking history were documented. Each scan was scored according to the presence of emphysema as follows: none, mild, moderate, or marked. Follow-up time was calculated from time of CT scan to time of death or December 31, 2007, whichever came fi rst. Cox regression analysis was used to calculate the hazard ratio (HR) of emphysema as a predictor of death. Results: Median age was 65 years, 4,433 (49%) were men, and 4,133 (46%) were currently smoking or had quit within 5 years. Emphysema was identifi ed in 2,637 (29%) and was a signifi cant predictor of death from COPD (HR, 9.3; 95% CI, 4.3-20.2; P , .0001) and from lung cancer (HR, 1.7; 95% CI, 1.1-2.5; P 5 .013), even when adjusted for age and smoking history. Conclusions: Visual asses...

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Section: Resultsmentioning

confidence: 89%

Emphysema Scores Predict Death From COPD and Lung Cancer

Zulueta

Wisnivesky

Henschke

et al. 2012

Chest

149

106

View full text Add to dashboard Cite

show abstract

“…DE TORRES et al [22] showed that emphysema found on computed tomography, but not airflow obstruction, was associated with an increased frequency of lung cancer. Results of lung cancer screening by the Mayo Clinic (Rochester, MN, USA) from multiple logistic regression models showed that emphysema (o5% on computed tomography) was associated with a 3.8-fold increased risk of lung cancer in Caucasians and with higher risks in subgroups that included younger people (,65 yrs of age, OR 4.64), heavy smokers (o40 pack-yrs, OR 4.46), and small-cell lung cancer (OR 5.62) [23]. Emphysema was assessed in these studies by visual semiquantitative scoring of computed tomography images.…”

Section: Epidemiology and Risk Of Lung Cancer In Copd Patientsmentioning

confidence: 99%

Early detection of COPD is important for lung cancer surveillance

Sekine¹,

Katsura²,

Koh³

et al. 2011

Eur Respir J

125

101

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It is well known that chronic obstructive pulmonary disease (COPD) is a significant risk factor for lung cancer. Approximately 1% of COPD patients develop lung cancer every year, which may be associated with genetic susceptibility to cigarette smoke. Chronic inflammation caused by toxic gases can induce COPD and lung cancer. Inflammatory mediators may promote the growth of bronchioalveolar stem cells, and activation of nuclear factor-kB and signal transducer and activator of transcription 3 play crucial roles in the development of lung cancer from COPD.Low-dose computed tomography (LDCT) is an effective procedure for the early detection of lung cancer in high-risk patients. However, determining which patients should be screened for lung cancer in a primary care setting is difficult. In this article, we review the epidemiology and aetiology of lung cancer associated with COPD, verify the efficacy of lung cancer screening by LDCT, and discuss the importance of early detection of COPD for lung cancer surveillance.We propose that, for the prevention of both diseases, COPD screening in smokers should be initiated as early as possible, so they can stop smoking and so that candidates for an efficient lung cancer screening programme can be identified.

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“…Impairment of NMC results in the accumulation of respiratory secretions and reduced lung defenses leading to infections, inflammation [4], and perhaps even neoplasia [8]. NMC thus functions as a biomarker of nasal mucosal function [9] and can serve as an early warning system for susceptibility to respiratory diseases.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Ageing on Nasal Mucociliary Clearance in Women: A Pilot Study

et al. 2013

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Introduction. Pneumonia is the leading infectious cause of death in the elderly. Impaired respiratory defences are one of the causes for increased susceptibility of the elderly to such infections. Nasal mucociliary clearance, the mirror image of bronchial clearance, is crucial in respiratory defence and is affected by various factors. Little is known about the effect of ageing on nasal respiratory epithelium. Aim. To evaluate the effect of ageing on nasal mucociliary clearance (NMC) in women. Materials and Methods. NMC was measured in 91 apparently healthy women of ages ranging from 20 to 80 years. The time taken to experience sweet taste at nasopharynx following the placement of saccharin pellet in the nostril was recorded as NMC time. Results and Discussion. NMC time was 10 min 36 secs in elderly women and it was significantly prolonged when compared to younger women (8 min 39 secs). The prolonged clearance may be due to altered cilia, slowed ciliary beating, or changes in the properties of mucus. Conclusion. NMC time clearly shows an increase with age signifying decreasing respiratory epithelium function. This study highlights an important cause of impaired respiratory health in older individuals and emphasises the need for preventive measures to be put in place.

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Effect of Emphysema on Lung Cancer Risk in Smokers: A Computed Tomography–Based Assessment

Cited by 90 publications

References 38 publications

Emphysema Scores Predict Death From COPD and Lung Cancer

Emphysema Scores Predict Death From COPD and Lung Cancer

Early detection of COPD is important for lung cancer surveillance

The Effect of Ageing on Nasal Mucociliary Clearance in Women: A Pilot Study

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