Emphysema phenotypes and lung cancer risk
González J (1), Henschke CI (2), Yankelevitz DF (2), Seijo LM (1), Reeves AP (3,4), Yip R (2), Xie Y (3), Chung M (2), Sánchez-Salcedo P (5), Alcaide AB (1), Campo A (1), Bertó J (1), Del Mar Ocón M (1), Pueyo J (6), Bastarrika G (6), de-Torres JP (1,7), Zulueta JJ (1,7,8,9).
(1) Pulmonary Service, Clínica Universidad de Navarra, Pamplona, Spain.
(2) Department of Radiology Mount Sinai School of Medicine, NY, United States of America.
(3) School of Electrical and Computer Engineering, Cornell University, Ithaca, NY, United States of America.
(4) Vision, Inc, Ithaca, NY, United States of America.
(5) Pulmonary Service, Complejo Hospitalario de Navarra, Pamplona, Spain.
(6) Radiology Department, Clínica Universidad de Navarra, Pamplona, Spain.
(7) Navarra's Health Research Institute (IDISNA), Pamplona, Spain.
(8) CIBERONC, ISCIII, Madrid, Spain.
(9) VisionGate, Inc, Phoenix, Arizona, United States of America.
To assess the relationship between lung cancer and emphysema subtypes.
Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment.
Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clínica Universidad de Navarra's lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes.
Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6).
Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.
CITA DEL ARTÍCULO PLoS One. 2019 Jul 25;14(7):e0219187. doi: 10.1371/journal.pone.0219187. eCollection 2019