de Torres Juan P, Bastarrika Gorka, Wisnivesky Juan P, Alcaide Ana B, Campo Arantza, Seijo Luis M, Pueyo Jesús C, Villanueva Alberto, Lozano María D, Montes Usua, Montuenga Luis, Zulueta Javier J
Department of Respiratory Diseases, University Clinic of Navarra, University of Navarra, Navarra, Spain.
Chest. 2007 Dec;132(6):1932-8. doi: 10.1378/chest.07-1490.
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.
To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer.
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.
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.
Results suggest that the presence of emphysema on LDCT is an independent risk factor for lung cancer.
识别肺癌的风险因素有助于挑选出可能从戒烟干预、早期检测或化学预防中获益最大的患者。
评估胸部低剂量CT（LDCT）上肺气肿的存在是否为肺癌的独立风险因素。
该研究使用了来自一项肺癌筛查研究的1166名既往和当前吸烟者的前瞻性队列数据。所有个体均接受了基线LDCT和肺活量测定，随后每年重复进行LDCT研究。估计了LDCT上有和没有肺气肿的患者中肺癌的发病密度。采用分层和多元回归分析来评估在调整年龄、性别、吸烟史和肺活量测定中气道阻塞的存在后，肺气肿是否为肺癌的独立风险因素。
单因素分析显示，LDCT上有和没有肺气肿的个体中肺癌的发病密度分别为每1000人年25.0例和每1000人年7.5例（风险比[RR]，3.33；95%置信区间[CI]，1.41至7.85）。当分析仅限于肺活量测定中没有气道阻塞的个体时，肺气肿也与肺癌风险增加相关（RR，4.33；95%CI，1.04至18.16）。多因素分析表明，在调整潜在混杂因素后，LDCT上肺气肿的存在（RR，2.51；95%CI，1.01至6.23）而非气道阻塞（RR，2.10；95%CI，0.79至5.58）与肺癌风险增加相关。
结果表明，LDCT上肺气肿的存在是肺癌的独立风险因素。
