Dept of Clinical Science, University of Bergen, Bergen, Norway
Dept of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Eur Respir J. 2017 May 11;49(5). doi: 10.1183/13993003.01162-2016. Print 2017 May.
There is limited knowledge about the prognostic value of quantitative computed tomography (CT) measures of emphysema and airway wall thickness in cancer.The aim of this study was to investigate if using CT to quantitatively assess the amount of emphysema and airway wall thickness independently predicts the subsequent incidence of non-pulmonary cancer and lung cancer.In the GenKOLS study of 2003-2005, 947 ever-smokers performed spirometry and underwent CT examination. The main predictors were the amount of emphysema measured by the percentage of low attenuation areas (%LAA) on CT and standardised measures of airway wall thickness (AWT-PI10). Cancer data from 2003-2013 were obtained from the Norwegian Cancer Register. The hazard ratio associated with emphysema and airway wall thickness was assessed using Cox proportional hazards regression for cancer diagnoses.During 10 years of follow-up, non-pulmonary cancer was diagnosed in 11% of the subjects with LAA <3%, in 19% of subjects with LAA 3-10%, and in 17% of subjects with LAA ≥10%. Corresponding numbers for lung cancer were 2%, 3% and 11%, respectively. After adjustment, the baseline amount of emphysema remained a significant predictor of the incidence of non-pulmonary cancer and lung cancer. Airway wall thickness did not predict cancer independently.This study offers a strong argument that emphysema is an independent risk factor for both non-pulmonary cancer and lung cancer.
关于肺气肿和气道壁厚度的定量计算机断层扫描 (CT) 测量在癌症中的预后价值的知识有限。本研究旨在探讨使用 CT 定量评估肺气肿和气道壁厚度的程度是否独立预测非肺部癌症和肺癌的后续发病率。在 2003-2005 年的 GenKOLS 研究中，947 名曾吸烟的人进行了肺活量测定和 CT 检查。主要预测因素是 CT 上低衰减区（%LAA）测量的肺气肿程度和气道壁厚度（AWT-PI10）的标准化测量。2003-2013 年的癌症数据来自挪威癌症登记处。使用 Cox 比例风险回归评估与肺气肿和气道壁厚度相关的癌症诊断的风险比。在 10 年的随访期间，LAA <3%的患者中有 11%被诊断出患有非肺部癌症，LAA 3-10%的患者中有 19%被诊断出患有非肺部癌症，LAA ≥10%的患者中有 17%被诊断出患有非肺部癌症。相应的肺癌数字分别为 2%、3%和 11%。调整后，基线肺气肿程度仍然是非肺部癌症和肺癌发病率的重要预测因素。气道壁厚度不能独立预测癌症。本研究有力地证明了肺气肿是非肺部癌症和肺癌的独立危险因素。
