Young R P, Hopkins R J, Christmas T, Black P N, Metcalf P, Gamble G D
Department of Medicine, University of Auckland, Auckland, New Zealand.
Eur Respir J. 2009 Aug;34(2):380-6. doi: 10.1183/09031936.00144208. Epub 2009 Feb 5.
Chronic obstructive pulmonary disease (COPD) is a common comorbid disease in lung cancer, estimated to affect 40-70% of lung cancer patients, depending on diagnostic criteria. As smoking exposure is found in 85-90% of those diagnosed with either COPD or lung cancer, coexisting disease could merely reflect a shared smoking exposure. Potential confounding by age, sex and pack-yr smoking history, and/or by the possible effects of lung cancer on spirometry, may result in over-diagnosis of COPD prevalence. In the present study, the prevalence of COPD (pre-bronchodilator Global Initiative for Chronic Obstructive Lung Disease 2+ criteria) in patients diagnosed with lung cancer was 50% compared with 8% in a randomly recruited community control group, matched for age, sex and pack-yr smoking exposure (n = 602, odds ratio 11.6; p<0.0001). In a subgroup analysis of those with lung cancer and lung function measured prior to the diagnosis of lung cancer (n = 127), we found a nonsignificant increase in COPD prevalence following diagnosis (56-61%; p = 0.45). After controlling for important variables, the prevalence of COPD in newly diagnosed lung cancer cases was six-fold greater than in matched smokers; this is much greater than previously reported. We conclude that COPD is both a common and important independent risk factor for lung cancer.
慢性阻塞性肺疾病（COPD）是肺癌中一种常见的合并症，根据诊断标准，估计影响40%-70%的肺癌患者。由于在85%-90%被诊断为COPD或肺癌的患者中发现有吸烟暴露史，共存疾病可能仅仅反映了共同的吸烟暴露情况。年龄、性别和吸烟包年史的潜在混杂因素，和/或肺癌对肺量计检查结果的可能影响，可能导致COPD患病率的过度诊断。在本研究中，被诊断为肺癌的患者中COPD的患病率（支气管扩张剂前慢性阻塞性肺疾病全球倡议2+标准）为50%，而在年龄、性别和吸烟包年暴露量匹配的随机招募社区对照组中为8%（n = 602，比值比11.6；p<0.0001）。在对肺癌诊断前测量过肺功能的肺癌患者亚组分析中（n = 127），我们发现诊断后COPD患病率无显著增加（56%-61%；p = 0.45）。在控制了重要变量后，新诊断肺癌病例中COPD的患病率比匹配的吸烟者高六倍；这比之前报道的要高得多。我们得出结论，COPD既是肺癌常见且重要的独立危险因素。
