Computed Tomography–Diagnosed Emphysema, Not Airway Obstruction, Is Associated with the Prognostic Outcome of Early-Stage Lung Cancer

• Published in: Clinical cancer research Vol. 12; no. 22; pp. 6730 - 6736
• Main Authors: UEDA, Kazuhiro, JINBO, Mitsutaka, LI, Tao-Sheng, YAGI, Takaharu, SUGA, Kazuyoshi, HAMANO, Kimikazu
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 15.11.2006
• Subjects: Aged; Airway Obstruction - diagnosis; Airway Obstruction - diagnostic imaging; Antineoplastic agents; Biological and medical sciences; Carcinoma, Non-Small-Cell Lung - diagnosis; Carcinoma, Non-Small-Cell Lung - etiology; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - therapy; chronic obstructive pulmonary disease (COPD); Chronic obstructive pulmonary disease, asthma; computed tomography (CT); Diagnosis, Differential; Disease-Free Survival; emphysema; Female; Humans; Lung Neoplasms - diagnosis; Lung Neoplasms - etiology; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; Male; Medical sciences; Middle Aged; Neoplasm Staging; non-small cell lung cancer; Pharmacology. Drug treatments; Pneumology; Prognosis; Pulmonary Emphysema - diagnosis; Pulmonary Emphysema - diagnostic imaging; Pulmonary Emphysema - etiology; Smoking - adverse effects; Survival Analysis; Tomography, X-Ray Computed - methods; Tumors of the respiratory system and mediastinum; Lung disease; Prognosis; Radiodiagnosis; Respiratory disease; Lung cancer; Early stage; Malignant tumor; Bronchopulmonary; Bronchus disease; Medical imagery; Airways obstruction; Computerized axial tomography; Obstructive pulmonary disease; Diagnosis; Emphysema
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1078-0432.CCR-06-1196

Purpose: Because both emphysema and lung cancer can arise from biological damage caused by cigarette smoking, we investigated if the development of emphysema is associated with the clinical features of smoker's lung cancer. Experimental Design: The subjects were a consecutive series of 100 smokers who underwent lobectomy with hilar and mediastinal dissection for clinical stage I non–small cell lung cancer. We studied the relationship between the presence or absence of emphysema at the onset of the lung cancer and clinicopathologic features. Emphysema was diagnosed by measuring the low-attenuation area using computed tomography densitometry. Results: There were no differences in clinicopathologic variables, including the degree of smoking exposure between the patients with ( n = 58) and those without ( n = 42) emphysema, although male gender and airflow limitation were predominant in the patients with emphysema. The presence of emphysema, but neither male gender nor airflow limitation, adversely affected both overall and disease-specific survival. According to Cox regression analysis, emphysema was an independent prognosticator among age, gender, degree of smoking exposure, tumor size, nodal status, histologic subtype, histologic grade, and microvessel invasion. These results were stabilized by a bootstrap sampling model. Conclusions: Computed tomography–diagnosed emphysema, but not airway obstruction, is associated with poor prognosis in smokers with early-stage lung cancer. Thus, routine computed tomography densitometry in smokers with lung cancer should be mandatory.