Wang Wei, Xie Mengshuang, Dou Shuang, Cui Liwei, Zheng Chunyan, Xiao Wei
Department of Pulmonary Medicine, Qilu Hospital, Shandong University, Jinan, Shandong, China.
Int J Chron Obstruct Pulmon Dis. 2018 Apr 13;13:1167-1175. doi: 10.2147/COPD.S158818. eCollection 2018.
COPD is considered an independent risk factor for lung cancer. COPD and lung cancer are both very heterogeneous diseases, and the study herein investigates the link between COPD phenotypes and specific histological subtypes of lung cancer.
This case-control study comprised 2,283 patients with newly diagnosed pathological lung cancer and 2,323 non-lung cancer controls. All participants underwent pulmonary function tests. The diagnosis of COPD was based on Global Initiative for Chronic Obstructive Lung Disease criteria. Subtypes of the two diseases were categorized according to 2015 World Health Organization classification of lung cancer and computer quantification of airway collapse on maximum expiratory flow volume. ORs were estimated using logistic regression analysis.
The prevalence of COPD was higher (32.8%) in lung cancer patients compared to controls (16.0%). After adjustment for age, sex, body-mass index, and smoking status, the presence of COPD significantly increased the risk of lung cancer (OR 2.88, 95% CI 2.48-3.34) and all common histological subtypes (ORs 2.04-5.26). Both emphysema-predominant and non-emphysema-predominant phenotypes of COPD significantly increased the risk of lung cancer (OR 4.43, 95% CI 2.85-6.88; OR 2.82, 95% CI 2.40-3.31). Higher risk of squamous-cell carcinoma and small-cell lung cancer was observed in patients with the emphysema-predominant than the non-emphysema-predominant phenotype (OR 1.73, 95% CI 1.03-2.89; OR 3.74, 95% CI 1.64-8.53).
COPD was an independent risk factor for lung cancer and all common histological subtypes. Both emphysema-predominant and non-emphysema-predominant phenotypes of COPD significantly increased the risk of lung cancer. Relative to non-emphysema-predominant phenotype of COPD, emphysema-predominant phenotype had a higher risk of squamous-cell carcinoma and small-cell lung cancer.
慢性阻塞性肺疾病（COPD）被认为是肺癌的独立危险因素。COPD和肺癌都是高度异质性疾病，本研究旨在调查COPD表型与肺癌特定组织学亚型之间的联系。
这项病例对照研究纳入了2283例新诊断的病理确诊肺癌患者和2323例非肺癌对照者。所有参与者均接受了肺功能测试。COPD的诊断基于慢性阻塞性肺疾病全球倡议标准。两种疾病的亚型根据2015年世界卫生组织肺癌分类以及最大呼气流量时气道塌陷的计算机定量进行分类。使用逻辑回归分析估计比值比（OR）。
肺癌患者中COPD的患病率（32.8%）高于对照组（16.0%）。在调整年龄、性别、体重指数和吸烟状况后，COPD的存在显著增加了肺癌风险（OR 2.88，95%可信区间[CI] 2.48 - 3.34）以及所有常见组织学亚型的风险（OR 2.04 - 5.26）。以肺气肿为主和不以肺气肿为主的COPD表型均显著增加了肺癌风险（OR 4.43，95% CI 2.85 - 6.88；OR 2.82，95% CI 2.40 - 3.31）。与不以肺气肿为主的表型相比，以肺气肿为主的表型患者患鳞状细胞癌和小细胞肺癌的风险更高（OR 1.73，95% CI 1.03 - 2.89；OR 3.74，95% CI 1.64 - 8.53）。
COPD是肺癌及所有常见组织学亚型的独立危险因素。以肺气肿为主和不以肺气肿为主的COPD表型均显著增加了肺癌风险。相对于不以肺气肿为主的COPD表型，以肺气肿为主的表型患鳞状细胞癌和小细胞肺癌的风险更高。
