Division of Pulmonary and Critical Care Medicine, University of Florida, Florida.
Complex Chest Disease Center, Massachusetts General Hospital, Massachusetts, USA.
Curr Opin Pulm Med. 2018 Mar;24(2):152-160. doi: 10.1097/MCP.0000000000000451.
Chronic obstructive pulmonary disease (COPD) is a well established risk factor for lung cancer. Newer studies reveal a myriad of other mechanisms, some proven and some putative, which may contribute to their association.
There is an ever-growing bundle of evidence that suggests a close association between persistent chronic inflammation and lung cancer. A few potential targets of genetic susceptibility locus for COPD and lung cancer have been suggested. Better characterization of immune dysregulation and identification of signaling pathways may assist the development of strategies to reduce risk of developing lung cancer in patients with COPD. Current lung cancer screening strategies may exclude some patients at high risk of having lung cancer. Prospective studies indicate that a screening criterion that includes variables reflecting the severity of COPD may increase the sensitivity of the screening program and reduce 'over-diagnosis bias' of indolent lung cancers. Examples of such variables include the emphysema score generated from computed tomography scans and diffusion capacity for carbon monoxide derived from lung function tests.
A better understanding of the inter-relationship between lung cancer pathogenesis and COPD has been described recently. Improving lung cancer screening strategies by incorporating markers of COPD severity has recently been proposed.
慢性阻塞性肺疾病（COPD）是肺癌的一个明确的危险因素。一些新的研究揭示了许多其他的机制，有些已经证实，有些则假设可能有助于它们之间的关联。
越来越多的证据表明，持续的慢性炎症与肺癌之间存在密切关联。已经提出了一些 COPD 和肺癌遗传易感性基因座的潜在靶点。更好地描述免疫失调和鉴定信号通路可能有助于制定策略，降低 COPD 患者肺癌的发病风险。目前的肺癌筛查策略可能会排除一些患有肺癌风险较高的患者。前瞻性研究表明，将反映 COPD 严重程度的变量纳入筛查标准可能会提高筛查计划的敏感性，并减少惰性肺癌的“过度诊断偏差”。例如，从 CT 扫描生成的肺气肿评分和从肺功能测试中得出的一氧化碳弥散量等变量。
最近描述了肺癌发病机制和 COPD 之间的相互关系。最近提出了通过纳入 COPD 严重程度标志物来改进肺癌筛查策略。
