Axelsson Gisli T, Putman Rachel K, Aspelund Thor, Gudmundsson Elias F, Hida Tomayuki, Araki Tetsuro, Nishino Mizuki, Hatabu Hiroto, Gudnason Vilmundur, Hunninghake Gary M, Gudmundsson Gunnar
Faculty of Medicine, University of Iceland, Reykjavik, Iceland
Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Eur Respir J. 2020 Dec 17;56(6). doi: 10.1183/13993003.02154-2019. Print 2020 Dec.
An increased incidence of lung cancer is well known among patients with idiopathic pulmonary fibrosis. It is not known whether interstitial lung abnormalities, early fibrotic changes of the lung, are a risk factor for lung cancer in the general population.The study's objective was to assess whether interstitial lung abnormalities were associated with diagnoses of, and mortality from, lung cancer and other cancers. Data from the AGES-Reykjavik study, a cohort of 5764 older Icelandic adults, were used. Outcome data were ascertained from electronic medical records. Gray's tests, Cox proportional hazards models and proportional subdistribution hazards models were used to analyse associations of interstitial lung abnormalities with lung cancer diagnoses and lung cancer mortality as well as diagnoses and mortality from all cancers.There was a greater cumulative incidence of lung cancer diagnoses (p<0.001) and lung cancer mortality (p<0.001) in participants with interstitial lung abnormalities than in others. Interstitial lung abnormalities were associated with an increased hazard of lung cancer diagnosis (hazard ratio 2.77) and lung cancer mortality (hazard ratio 2.89) in adjusted Cox models. Associations of interstitial lung abnormalities with all cancers were found in models including lung cancers but not in models excluding lung cancers.People with interstitial lung abnormalities are at increased risk of lung cancer and lung cancer mortality, but not of other cancers. This implies that an association between fibrotic and neoplastic diseases of the lung exists from the early stages of lung fibrosis and suggests that interstitial lung abnormalities could be considered as a risk factor in lung cancer screening efforts.
特发性肺纤维化患者中肺癌发病率增加是众所周知的。尚不清楚间质性肺异常，即肺部早期纤维化改变，在普通人群中是否为肺癌的危险因素。该研究的目的是评估间质性肺异常是否与肺癌及其他癌症的诊断和死亡率相关。使用了AGES-雷克雅未克研究的数据，该研究队列包括5764名冰岛老年成年人。结局数据通过电子病历确定。采用格雷检验、Cox比例风险模型和比例子分布风险模型来分析间质性肺异常与肺癌诊断、肺癌死亡率以及所有癌症的诊断和死亡率之间的关联。与其他参与者相比，存在间质性肺异常的参与者肺癌诊断的累积发病率（p<0.001）和肺癌死亡率（p<0.001）更高。在调整后的Cox模型中，间质性肺异常与肺癌诊断风险增加（风险比2.77）和肺癌死亡率（风险比2.89）相关。在包括肺癌的模型中发现了间质性肺异常与所有癌症之间的关联，但在排除肺癌的模型中未发现。存在间质性肺异常的人患肺癌和肺癌死亡的风险增加，但患其他癌症的风险未增加。这意味着从肺纤维化的早期阶段起，肺部纤维化疾病与肿瘤性疾病之间就存在关联，并表明间质性肺异常可被视为肺癌筛查工作中的一个危险因素。
