Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest
Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest
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DOI：
10.1378/chest.07-1490
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发表时间：
2007-12-01
期刊：
影响因子：
9.6
通讯作者：
Zulueta, Javier J.
中科院分区：
文献类型：
--
作者：
de Torres, Juan P.;Bastarrika, Gorka;Zulueta, Javier J.
基本原理：识别肺癌的危险因素有助于选择可能从戒烟干预、早期发现或化学预防中获益最多的患者。目的：为了评估是否存在肺气肿的低辐射剂量CT（LDCT）的胸部是一个独立的危险因素肺癌。方法：本研究使用的数据来自一个前瞻性队列的1,166名前和当前吸烟者参加肺癌筛查研究。所有个体均接受基线LDCT和肺功能测定，然后每年重复LDCT研究。估计LDCT上有肺气肿和无肺气肿的患者中肺癌的发病密度。在调整年龄、性别、吸烟史和肺量测定法上存在的气道阻塞后，采用分层和多元回归分析评估肺气肿是否是肺癌的独立危险因素。在单变量分析中，LDCT显示有肺气肿和无肺气肿个体的肺癌发病率密度分别为25.0/1000人-年和7.5/1，000人-年（风险比[RR]，3.33; 95%置信区间[CI]，1.41至7.85）。当分析仅限于肺量测定法显示无气道阻塞的个体时，肺气肿也与肺癌风险增加相关（RR，4.33; 95%CI，1.04 - 18.16）。多因素分析显示肺气肿的存在（RR，2.51; 95% CI，1.01至6.23），但不包括气道阻塞（RR，2.10; 95%CI，0.79至5.58）与调整潜在共同因素后肺癌风险增加相关。结果表明，肺气肿的LDCT上的存在是肺癌的一个独立的危险因素。
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.Results: On univariate analysis, the incidence density of lung cancer among individuals with and without emphysema on LDCT was 25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also associated with increased risk of lung cancer when the analysis was limited to individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to 18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51; 95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79 to 5.58) was associated with increased risk of lung cancer after adjusting for potential cofounders.Conclusions: Results suggest that the presence of emphysema on LDCT is an independent risk factor for lung cancer.