Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.
Pulm Pharmacol Ther. 2013 Oct;26(5):544-54. doi: 10.1016/j.pupt.2013.05.003. Epub 2013 May 21.
Chronic obstructive pulmonary disease (COPD) affects more than 200 million people worldwide and is expected to become the third leading cause of death in 2020. COPD is characterized by progressive airflow limitation, due to a combination of chronic inflammation and remodeling of the small airways (bronchiolitis) and loss of elastic recoil caused by destruction of the alveolar walls (emphysema). Lung cancer is the most important cause of cancer-related death in the world. (Cigarette) smoking is the principal culprit causing both COPD and lung cancer; in addition, exposure to environmental tobacco smoke, biomass fuel smoke, coal smoke and outdoor air pollution have also been associated with an increased incidence of both diseases. Importantly, smokers with COPD--defined as either not fully reversible airflow limitation or emphysema--have a two- to four-fold increased risk to develop lung cancer. In this review, we highlight several of the genetic, epigenetic and inflammatory mechanisms, which link COPD and carcinogenesis in the lungs. Elucidating the biological pathways and networks, which underlie the increased susceptibility of lung cancer in patients with COPD, has important implications for screening, prevention, diagnosis and treatment of these two devastating pulmonary diseases.
慢性阻塞性肺疾病（COPD）影响着全球超过 2 亿人，预计它将成为 2020 年的第三大死因。COPD 的特征是气流受限进行性加重，这是由于小气道（细支气管炎）的慢性炎症和重塑以及肺泡壁破坏导致弹性回缩丧失（肺气肿）的共同作用。肺癌是全球癌症相关死亡的最重要原因。（香烟）吸烟是导致 COPD 和肺癌的主要元凶；此外，接触环境烟草烟雾、生物质燃料烟雾、煤烟和室外空气污染也与这两种疾病的发病率增加有关。重要的是，COPD 患者（定义为气流受限不完全可逆或肺气肿）患肺癌的风险增加了 2 到 4 倍。在这篇综述中，我们强调了几种遗传、表观遗传和炎症机制，这些机制将 COPD 和肺癌的发生联系起来。阐明 COPD 患者肺癌易感性增加的生物学途径和网络，对这两种严重肺部疾病的筛查、预防、诊断和治疗具有重要意义。
