Mannino David M, Aguayo Samuel M, Petty Thomas L, Redd Stephen C
Air Pollution and Respiratory Health Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Arch Intern Med. 2003 Jun 23;163(12):1475-80. doi: 10.1001/archinte.163.12.1475.
Obstructive lung disease and lung cancer are tobacco-related diseases that can remain clinically silent until late in the disease process. We sought to define the risk for incident lung cancer among a national cohort of US adults with and without obstructive lung disease.
We studied participants in the First National Health and Nutrition Examination Survey, who had up to 22 years of follow-up. We classified subjects as having moderate or severe obstructive lung disease at baseline if the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) was less than 70% and the FEV1 was less than 80% of the predicted value. We also determined incident cases of lung cancer during the follow-up period.
A total of 113 lung cancers occurred in the 5402 adults in the cohort. In the proportional hazards model adjusted for covariates of age, sex, race, education, smoking status, and duration and intensity of smoking, the presence of moderate or severe obstructive lung disease was associated with a higher risk for incident lung cancer (hazard ratio, 2.8; 95% confidence interval, 1.8-4.4).
The presence of moderate or severe obstructive lung disease is a significant predictor of incident lung cancer in long-term follow-up. This finding may be useful clinically and in studies evaluating the utility of new tools for the early detection of lung cancer.
阻塞性肺病和肺癌是与烟草相关的疾病，在疾病进程晚期之前可能在临床上没有症状。我们试图确定美国有和没有阻塞性肺病的成年人群体中患肺癌的风险。
我们研究了第一次全国健康和营养检查调查中的参与者，他们有长达22年的随访。如果1秒用力呼气量（FEV1）与用力肺活量（FVC）的比值小于70%且FEV1小于预测值的80%，我们将基线时的受试者分类为患有中度或重度阻塞性肺病。我们还确定了随访期间肺癌的发病病例。
该队列中的5402名成年人中共有113例肺癌发生。在根据年龄、性别、种族、教育程度、吸烟状况以及吸烟持续时间和强度等协变量进行调整的比例风险模型中，中度或重度阻塞性肺病与肺癌发病风险较高相关（风险比，2.8；95%置信区间，1.8 - 4.4）。
中度或重度阻塞性肺病的存在是长期随访中肺癌发病的重要预测因素。这一发现可能在临床以及评估肺癌早期检测新工具效用的研究中有用。
