韩国的快速 FEV 下降与肺癌发病率。

Rapid FEV Decline and Lung Cancer Incidence in South Korea.

机构信息

Division of Pulmonary and Critical Care, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.

出版信息

Chest. 2022 Aug;162(2):466-474. doi: 10.1016/j.chest.2022.03.018. Epub 2022 Mar 19.

DOI:10.1016/j.chest.2022.03.018

PMID:35318007

Abstract

BACKGROUND

Impaired lung function is associated with a higher risk of developing lung cancer. However, lung function is a dynamic variable and must be evaluated longitudinally. This study reports on the relationship between accelerated lung function decline and development of lung cancer.

RESEARCH QUESTION

Is accelerated lung function decline associated with the development of lung cancer?

STUDY DESIGN AND METHODS

A longitudinal, observational study was performed by using epidemiologic data from two population-based studies comprising subjects assessed biannually from 2001 to 2019 in South Korea. Eligible subjects were between 40 and 69 years of age and were followed up by using spirometry. Spirometry measurements were made at each follow-up. Patients with a decline in FEV > 60 mL per year were defined as rapid FEV decliners. The relationship between lung cancer and rapid FEV decline was evaluated by using adjusted Cox regression models with covariates, including age, sex, smoking history, FEV/FVC, and WBC count.

RESULTS

Among the 8,549 eligible subjects, 1,287 (15.1%) had rapid FEV decline, and 48 (0.6%) had newly developed lung cancer. The risk of lung cancer development was increased in the subjects aged ≥ 45 years and those with ≥ 30 pack-years of smoking, low baseline FEV/FVC, low forced expiratory flow between 25% and 75% of vital capacity, rapid FEV decline, and increased WBC count. Rapid FEV decline was an independent risk factor for lung cancer development (adjusted hazard ratio, 2.34; 95% CI, 1.28-4.28; P = .006). Time-dependent net reclassification improvement showed a benefit of FEV decline rate in determining subjects at risk of lung cancer when added to conventional practice (categorical, 0.32 [95% CI, 0.00-0.64]; continuous, 0.83 [95% CI, 0.14-1.25]).

INTERPRETATION

The FEV decline rate may be a potential biomarker for lung cancer development. Further study is needed to identify whether patients with rapid FEV decline warrant lung cancer assessment or screening.

摘要

背景

肺功能受损与肺癌风险增加相关。然而，肺功能是一个动态变量，必须进行纵向评估。本研究报告了肺功能下降加速与肺癌发展之间的关系。

研究问题

肺功能下降加速是否与肺癌的发生有关？

研究设计和方法

这是一项使用来自韩国两项基于人群的研究的流行病学数据进行的纵向观察性研究，这些研究对象在 2001 年至 2019 年间每两年接受一次评估。合格的研究对象年龄在 40 岁至 69 岁之间，并通过肺活量测定法进行随访。每次随访都进行肺活量测量。每年 FEV 下降>60ml 的患者被定义为快速 FEV 下降者。使用调整后的 Cox 回归模型，包括年龄、性别、吸烟史、FEV/FVC 和白细胞计数等协变量，评估肺癌与快速 FEV 下降之间的关系。

结果

在 8549 名合格的研究对象中，1287 名（15.1%）有快速 FEV 下降，48 名（0.6%）患有新发性肺癌。年龄≥45 岁、吸烟≥30 包年、基线 FEV/FVC 较低、用力肺活量 25%至 75%之间的强制呼气流量较低、快速 FEV 下降和白细胞计数增加的患者发生肺癌的风险增加。快速 FEV 下降是肺癌发展的独立危险因素（调整后的危险比为 2.34；95%CI，1.28-4.28；P=0.006）。时间依赖性净重新分类改善表明，在常规实践中加入 FEV 下降率可以更好地确定肺癌风险患者（分类，0.32[95%CI，0.00-0.64]；连续，0.83[95%CI，0.14-1.25]）。