Features of COPD as Predictors of Lung Cancer
Features of COPD as Predictors of Lung Cancer
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DOI：
10.1016/j.chest.2018.01.049
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发表时间：
2018-06-01
期刊：
影响因子：
9.6
通讯作者：
Bowler, Russell P.
中科院分区：
文献类型：
--
作者：
Carr, Laurie L.;Jacobson, Sean;Bowler, Russell P.
背景：肺癌是COPD患者死亡和住院的主要原因。详细了解哪些临床特征的COPD增加risk is needed.METHODS：我们进行了一项巢式病例对照研究的COPD遗传流行病学（COPDGene）研究对象与肺癌和非肺癌，年龄45至80岁，谁吸烟至少10包年，以确定临床和影像学特征的吸烟者，有和没有COPD，与肺癌的风险增加。基线评估包括肺功能测定、高分辨率胸部CT扫描和呼吸问卷调查。新的肺癌诊断是在8年的纵向随访中确定的。肺癌病例与对照组在年龄、种族、性别和吸烟史方面1：4匹配。多元逻辑回归分析用于确定预测肺癌的特征。与未来肺癌风险相关的特征包括FEV 1/FVC降低（OR，1.28/10%降低[95% CI，1.12-1.46]），肺气肿的视觉严重程度（OR，2.31，无痕量vs轻度-晚期[95% CI，1.41-3.86]）和研究入组前呼吸加重（OR，1.39/事件增加[0、1和$2] [95% CI，1.04-1.85]）。呼吸道恶化也与小细胞肺癌组织学相关（OR，3.57 [95%CI，1.47-10]）。结论：COPD的严重程度，包括气流阻塞、可见肺气肿和呼吸道恶化，是肺癌的独立预测因素。这些危险因素应作为肺癌筛查生存获益的纳入和排除标准进行进一步研究。需要进行研究以确定减少吸烟者的呼吸恶化是否可以降低肺癌的风险。
BACKGROUND: Lung cancer is a leading cause of death and hospitalization for patients with COPD. A detailed understanding of which clinical features of COPD increase risk is needed.METHODS: We performed a nested case-control study of Genetic Epidemiology of COPD (COPDGene) Study subjects with and without lung cancer, age 45 to 80 years, who smoked at least 10-pack years to identify clinical and imaging features of smokers, with and without COPD, that are associated with an increased risk of lung cancer. The baseline evaluation included spirometry, high-resolution chest CT scanning, and respiratory questionnaires. New lung cancer diagnoses were identified over 8 years of longitudinal follow-up. Cases of lung cancer were matched 1:4 with control subjects for age, race, sex, and smoking history. Multiple logistic regression analyses were used to determine features predictive of lung cancer.RESULTS: Features associated with a future risk of lung cancer included decreased FEV1/FVC (OR, 1.28 per 10% decrease [95% CI, 1.12-1.46]), visual severity of emphysema (OR, 2.31, none-trace vs mild-advanced [95% CI, 1.41-3.86]), and respiratory exacerbations prior to study entry (OR, 1.39 per increased events [0, 1, and $2] [95% CI, 1.04-1.85]). Respiratory exacerbations were also associated with small-cell lung cancer histology (OR, 3.57 [95% CI, 1.47-10]).CONCLUSIONS: The degree of COPD severity, including airflow obstruction, visual emphysema, and respiratory exacerbations, was independently predictive of lung cancer. These risk factors should be further studied as inclusion and exclusion criteria for the survival benefit of lung cancer screening. Studies are needed to determine if reduction in respiratory exacerbations among smokers can reduce the risk of lung cancer.