The Incidence and Risk Analysis of Lung Cancer Development in Patients with Chronic Obstructive Pulmonary Disease: Possible Effectiveness of Annual CT-Screening

Abstract

Purpose Lung cancer is a serious complication in patients with chronic obstructive pulmonary disease (COPD) and accounts for approximately 15% of deaths in patients with COPD. However, with the exception of emphysema, few reports to date have been published on the factors that predict lung cancer development in COPD patients. It has been reported that patients with COPD develop lung cancer at a rate of 0.8% - 1.7%/year, but the incidence may be higher in the Japanese population. Therefore, we investigated the incidence of lung cancer and the lung cancer mortality rate in Japanese COPD patients, as well as factors that are associated with the development of lung cancer in COPD patients. Patients and Methods We followed up 224 patients with stable COPD and performed CT examinations at least once per year. The incidence of lung cancer was recorded and data at enrollment were compared with data of the group that did not develop lung cancer. Results Over a median follow-up period of 4.58 years, lung cancer was newly diagnosed in 19 patients; the incidence of lung cancer in this population was 1.85%/year. Patients who developed lung cancer had more severe emphysema assessed by CT and GOLD classification and were more likely to be current smokers than those who did not develop lung cancer. No other significant differences were observed between these two groups. Mortality was significantly increased in patients who developed lung cancer compared with those who did not. Conclusion In COPD patients, the incidence of lung cancer is higher and the development of lung cancer worsens the prognosis; however, lung cancer development is unpredictable and attention should be paid to all patients. Annual CT screening is important for early detection of lung cancer.

Prevalence of lung cancer in chronic obstructive pulmonary disease: A systematic review and meta-analysis

“…A total of 8,254 related studies were retrieved through electronic and manual searching from the initial examination, of which 1,681 duplicates, 6,573 unrelated studies were excluded after reading titles and abstracts. After screening qualified articles by reading the full text, 31 (13,(22)(23)(24)(25)(26) studies were included in the meta-analysis. The study selection process is shown in (Figure 1).…”

“…Overall, we included 31studies covering 829,490 patients with COPD, including twenty-one (13,(22)(23)(24)(25)(26)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)) cohort studies, three (27, 49, 50) case-control studies and seven (28, 29, 51-55) cross-sectional studies. These studies were published from 2003 to 2022 with definite diagnostic criteria, and the sample sizes ranged from 198 to 236,494.…”

“…In terms of sex, nine studies (22,26,39,41,44,48,49,54,54) investigated the prevalence of lung cancer in male patients with COPD, covering 62,627 individuals, with a prevalence ranging from 1.54% to 8.89%, and the estimated pooled prevalence was 5.09% (95% CI: 3.48-6.70%; I 2 = 98.8%, P = 0.000). Eight (22,26,41,44,48,49,53,54) studies illustrated that the prevalence of lung cancer in female patients with COPD was 2.52% (95% CI: 1.57-4.05%; I 2 = 99.9%, P = 0.000) (Table 4). Six studies comprehensively described the influence of smoking status on the prevalence of lung cancer in patients with COPD.…”

“…Regarding the severity of COPD, six studies (26, 39, 40, 42, 48, 54) provided comprehensive information on the incidence of COPD combined with lung cancer at different stages. Among them, six (26,39,40,42,48,54), three (26,40,42), and two (26,42) studies reported lung cancer prevalence in patients with Forest plot showing the prevalence of lung cancer in COPD. mild, moderate, and severe COPD, respectively, with a pooled prevalence of 3.89% (95% CI: 2.14-7.06%; I 2 = 99.4%, P = 0.000), 6.67% (95% CI: 3.20-10.14%; I 2 = 87%, P = 0.000), and 5.57% ( 9 5 % C I : 1 .…”

“…Smoking status was examined in six studies (24-26, 39, 48, 49), and the analysis results indicated that smoking status of any type did increase the risk of lung cancer, with current smokers showing a higher risk (P ≤ 0.05). Five studies (24,26,40,42,48) focused on the COPD severity as a risk factor for lung cancer, and the results (pooled OR) showed that the risk was statistically significant in patients with mild and moderate COPD (Table 5).…”