Jewish General Hospital affiliated with McGill University, Montreal, Canada.
Lung Cancer. 2012 Apr;76(1):61-6. doi: 10.1016/j.lungcan.2011.09.003. Epub 2011 Sep 25.
Multiple studies have demonstrated an increased risk of lung cancer in the presence of emphysema detected visually on computed tomography (CT) independent of smoking history and airflow obstruction. The relationship between emphysema and specific histologic subtypes of lung cancer remains uncertain.
To determine the extent to which emphysema on chest CT is associated with lung cancer histology.
Cross-sectional analysis of consecutive lung cancer patients referred to the Jewish General Hospital was performed (2001-2009). All those with demographic data, smoking history (pack-years), documented histology and chest CT were included. Emphysema was graded on CT by three readers, using a standardized rubric. Odds of each lung cancer subtype were compared between patients with and without emphysema, and adjusted for age, sex, physician diagnosed COPD and smoking history by multiple logistic regression.
Complete data were available for 498 lung cancer patients (mean age 68 years; 44% female; 16% never smokers; 53% without emphysema on CT). The most common histologies were adenocarcinoma (242 [49%]), squamous (71 [14%]), undifferentiated (48 [10%]) and small cell carcinoma (42 [8%]). The presence of emphysema was associated with increased odds of squamous (OR 3.1; 95% CI 1.8-5.3) and small cell (OR 2.1; 95% CI 1.1-4.1) carcinoma. After adjustment for age, sex, COPD and smoking history, emphysema was associated with squamous (adjusted OR 2.6; 95% CI 1.4-4.8) but not small cell (adjusted OR 1.5; 95% CI 0.76-3.1) carcinoma. Sensitivity analysis was performed by sequential censoring of each histologic subtype yielding similar results. Adenocarcinoma was less common in the presence of emphysema relative to squamous and small cell carcinoma (adjusted OR 0.62; 95% CI 0.41-0.92). When these latter histologies were censored, no significant association between adenocarcinoma and emphysema was observed (adjusted OR 1.0; 95% CI 0.49-2.1).
Relative to other histologic subtypes, the odds of squamous carcinoma were significantly increased among lung cancer patients with emphysema after adjustment for age, sex, COPD and smoking history. Other common subtypes were not independently associated with emphysema.
多项研究表明，在 CT 上独立于吸烟史和气流阻塞检测到肺气肿的情况下，肺癌的风险增加。肺气肿与肺癌的特定组织学亚型之间的关系仍不确定。
确定 CT 上的肺气肿与肺癌组织学之间的关联程度。
对 2001 年至 2009 年转诊至犹太总医院的连续肺癌患者进行了横断面分析。所有患者均具有人口统计学数据、吸烟史（包年数）、明确的组织学和胸部 CT 资料。肺气肿通过三位读者使用标准化标准在 CT 上分级。通过多变量逻辑回归，比较肺气肿患者和无肺气肿患者之间的每种肺癌亚型的可能性，并针对年龄、性别、医生诊断的 COPD 和吸烟史进行调整。
498 例肺癌患者（平均年龄 68 岁；44%为女性；16%为从不吸烟者；53%的患者在 CT 上无肺气肿）的完整数据可用。最常见的组织学类型是腺癌（242 例[49%]）、鳞状细胞癌（71 例[14%]）、未分化癌（48 例[10%]）和小细胞癌（42 例[8%]）。肺气肿的存在与鳞状细胞癌（OR 3.1；95%CI 1.8-5.3）和小细胞癌（OR 2.1；95%CI 1.1-4.1）的可能性增加有关。在调整年龄、性别、COPD 和吸烟史后，肺气肿与鳞状细胞癌（调整 OR 2.6；95%CI 1.4-4.8）相关，但与小细胞癌（调整 OR 1.5；95%CI 0.76-3.1）无关。通过对每种组织学亚型进行顺序剔除的敏感性分析得出了类似的结果。与鳞状细胞癌和小细胞癌相比，肺气肿患者中腺癌的发生频率较低（调整 OR 0.62；95%CI 0.41-0.92）。当剔除这些后两种组织学类型时，腺癌与肺气肿之间没有观察到显著关联（调整 OR 1.0；95%CI 0.49-2.1）。
在调整年龄、性别、COPD 和吸烟史后，与其他组织学亚型相比，肺气肿肺癌患者中鳞状细胞癌的可能性显著增加。其他常见亚型与肺气肿无独立相关性。
