Emphysema detected by lung cancer screening with low‐dose spiral CT: Prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects

Omori, Hisamitsu; Nakashima, Rumi; Otsuka, Naruhito; Mishima, Yoshiko; Tomiguchi, Seigi; Narimatsu, A; Nonami, Yoshio; Mihara, Shuichi; Koyama, Wasaku; Marubayashi, Toru; Morimoto, Yasuo

doi:10.1111/j.1440-1843.2006.00827.x

Cited by 66 publications

(58 citation statements)

References 28 publications

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“…Approximately one-third of the study cohort had CT scan fi ndings of emphysema, a proportion similar to that found in other lung cancer screening studies from Spain 7 and Japan. 12 As mentioned previously, in one by the associations between CT scan evidence for emphysema, the diagnosis of lung cancer, and death from COPD and lung cancer. The current data also show that a considerable proportion of asymptomatic smokers have evidence of smoking status.…”

Section: Resultsmentioning

confidence: 99%

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: 99%

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

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“…Data on the epidemiology of emphysema in ''healthy'' smokers are forthcoming from populations screened by lung cancer [24][25][26]. Both prevalence and severity of emphysema on lowdose CT have already been shown to be greater in male than in female smokers [24,26].…”

Section: Discussionmentioning

confidence: 99%

Sex differences in emphysema phenotype in smokers without airflow obstruction

et al. 2009

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Data on sex differences in emphysema are limited to chronic obstructive pulmonary disease. We aimed to verify whether such differences also exist in smokers without airflow obstruction, weighting their influence on the relationship between emphysema and clinical features.We evaluated both clinical and multidetector computed tomography (MDCT) data of 1,011 heavy smokers recruited by a lung cancer screening project. MDCT scans were analysed with software allowing lobar quantification of emphysema features. For these measures, multiple regression models were applied to assess the effect of patients sex, after allowance for age, body mass index (BMI), smoking history, forced expiratory volume in 1 s (FEV1) and forced vital capacity.The final study cohort consisted of 957 smokers without airflow obstruction. Compared with males, females exhibited an emphysema phenotype less extensive in each pulmonary lobe, characterised by smaller emphysematous areas and less concentrated in the core of the lung. However, in females, the increase of emphysema with age was more pronounced and displayed a more significant relationship with FEV1% decline; conversely, in males there was a stronger association with the decrease in BMI.Males and females respond differently to the type and location of lung damage due to tobacco exposure. In smokers, sex influences the relationship between emphysema and clinical features.

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“…However, it has been shown that qualitative assessment is a valid and reliable tool for the characterization of emphysema on CT. 6 Furthermore, the prevalence of emphysema based on qualitative measurements in this study population is similar to what has been reported in other series of high-risk individuals. 29 Lastly, we lacked complete information about current smoking status of some study participants. Thus, we were not able to adjust for the potential influence of smoking status (current vs former) on the risk of lung cancer in the multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

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

de-Torres

Bastarrika

Wisnivesky

et al. 2007

Chest

399

303

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Rationale: Identification of risk factors for lung cancer can help in selecting patients who may benefit the most from smoking cessation interventions, early detection, or chemoprevention. Objective: To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer. Methods: The study used data from a prospective cohort of 1,166 former and current smokers participating in a lung cancer screening study. All individuals underwent a baseline LDCT and spirometry followed by yearly repeat LDCT studies. The incidence density of lung cancer among patients with and without emphysema on LDCT was estimated. Stratified and multiple regression analyses were used to assess whether emphysema is an independent risk factor for lung cancer after adjusting for age, gender, smoking history, and the presence of airway obstruction on spirometry. Abbreviations: CI ϭ confidence interval; IQR ϭ interquartile range; LDCT ϭ low-radiation-dose CT; RR ϭ risk ratio L ung cancer is the deadliest malignancy in the world among men and women.

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Emphysema detected by lung cancer screening with low‐dose spiral CT: Prevalence, and correlation with smoking habits and pulmonary function in Japanese male subjects

Abstract: A considerable percentage of the subjects with emphysema as detected by CT screening had GOLD stage 0. CT screening assists in detecting early-stage emphysema.

Cited by 66 publications

References 28 publications

Emphysema Scores Predict Death From COPD and Lung Cancer

Emphysema Scores Predict Death From COPD and Lung Cancer

Sex differences in emphysema phenotype in smokers without airflow obstruction

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

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