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. 2008 Oct 1;178(7):738-44.
doi: 10.1164/rccm.200803-435OC. Epub 2008 Jun 19.

Association of radiographic emphysema and airflow obstruction with lung cancer

David O Wilson  1 , Joel L Weissfeld, Arzu Balkan, Jeffrey G Schragin, Carl R Fuhrman, Stephen N Fisher, Jonathan Wilson, Joseph K Leader, Jill M Siegfried, Steven D Shapiro, Frank C Sciurba
Affiliations

Association of radiographic emphysema and airflow obstruction with lung cancer

David O Wilson et al. Am J Respir Crit Care Med. .

Abstract

Rationale: To study the relationship between emphysema and/or airflow obstruction and lung cancer in a high-risk population.

Objective: We studied lung cancer related to radiographic emphysema and spirometric airflow obstruction in tobacco-exposed persons who were screened for lung cancer using chest computed tomography (CT).

Methods: Subjects completed questionnaires, spirometry, and low-dose helical chest CT. CT scans were scored for emphysema based on National Emphysema Treatment Trial criteria. Multiple logistic regressions estimated the independent associations between various factors, including radiographic emphysema and airflow obstruction, and subsequent lung cancer diagnosis.

Measurements and main results: Among 3,638 subjects, 57.5, 18.8, 14.6, and 9.1% had no, trace, mild, and moderate-severe emphysema, and 57.3, 13.6, 22.8, and 6.4% had no, mild (Global Initiative for Chronic Obstructive Lung Disease [GOLD] I), moderate (GOLD II), and severe (GOLD III-IV) airflow obstruction. Of 3,638 subjects, 99 (2.7%) received a lung cancer diagnosis. Adjusting for sex, age, years of cigarette smoking, and number of cigarettes smoked daily, logistic regression showed the expected lung cancer association with the presence of airflow obstruction (GOLD I-IV, odds ratio [OR], 2.09; 95% confidence interval [CI], 1.33-3.27). A second logistic regression showed lung cancer related to emphysema (OR, 3.56; 95% CI, 2.21-5.73). After additional adjustments for GOLD class, emphysema remained a strong and statistically significant factor related to lung cancer (OR, 3.14; 95% CI, 1.91-5.15).

Conclusions: Emphysema on CT scan and airflow obstruction on spirometry are related to lung cancer in a high-risk population. Emphysema is independently related to lung cancer. Both radiographic emphysema and airflow obstruction should be considered when assessing lung cancer risk.

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Figures

<b>Figure 1.</b>
Figure 1.
Lung cancer associations with airflow obstruction (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage) and radiographic emphysema, odds ratio (diamonds), and 95% confidence intervals (whiskers), adjusted for sex, age, years of cigarette smoking, and cigarette smoking dose intensity (in four categories).
<b>Figure 2.</b>
Figure 2.
Association between radiographic emphysema and lung cancer (odds ratio and 95% confidence interval), adjusted for sex, age, years of cigarette smoking, cigarette smoking dose intensity (in four categories), and airflow obstruction (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage, in four categories).
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