Division of Thoracic Surgery, Shizuoka Cancer Center, Sunto-gun, Japan.
Department of Surgery, Yokohama City University, Kanazawa, Japan.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac499.
Although pulmonary emphysema is a component of chronic obstructive pulmonary disease, the prognostic significance of the quantitative severity of emphysema in patients with primary lung cancer is unclear. This study aimed to identify the association between the quantitative severity of emphysema detected by the low-attenuation area on computed tomography and the prognostic outcome of early non-small-cell lung cancer.
A consecutive series of 1062 patients who underwent lobectomy for clinical stage I and II non-small-cell lung cancer were enrolled in this study. The clinicopathological features and long-term outcomes of patients with primary lung cancer in emphysema were investigated. The extent of emphysema in the lobe where the tumour was present was measured by preoperative computed tomography as a percentage of the low-attenuation area (LAA%).
LAA% ≥ 1.0% was detected in 145 (13.7%) patients. LAA% was associated with pleural invasion (P < 0.0001), vascular invasion (P < 0.0001) and a larger tumour size (P = 0.001). The overall survival and recurrence-free survival in patients with LAA% ≥ 1.0% and with LAA% < 1.0% at 5 years were 78.6% and 92.1% (P < 0.0001) and 68.7% and 85.2% (P < 0.0001), respectively. According to the Cox proportional hazards model, LAA% was an independent prognostic factor for overall survival and recurrence-free survival (P = 0.0004 and P = 0.003, respectively).
The quantitative severity of pulmonary emphysema was found to be associated with poor prognosis and clinicopathological aggression in early non-small-cell lung cancer.
虽然肺气肿是慢性阻塞性肺疾病的一个组成部分，但原发性肺癌患者肺气肿定量严重程度的预后意义尚不清楚。本研究旨在确定计算机断层扫描（CT）检测到的肺气肿定量严重程度与早期非小细胞肺癌（NSCLC）患者预后结局之间的关系。
本研究纳入了 1062 例连续接受 lobectomy 治疗的 I 期和 II 期 NSCLC 患者。研究了肺气肿患者原发性肺癌的临床病理特征和长期预后。通过术前 CT 测量肿瘤所在肺叶中肺气肿的程度，以低衰减区（LAA%）的百分比表示。
145 例（13.7%）患者检测到 LAA%≥1.0%。LAA%与胸膜侵犯（P < 0.0001）、血管侵犯（P < 0.0001）和肿瘤较大（P=0.001）相关。LAA%≥1.0%和 LAA%<1.0%的患者 5 年总生存率和无复发生存率分别为 78.6%和 92.1%（P < 0.0001）和 68.7%和 85.2%（P < 0.0001）。根据 Cox 比例风险模型，LAA%是总生存率和无复发生存率的独立预后因素（P=0.0004 和 P=0.003）。
发现肺气肿的定量严重程度与早期非小细胞肺癌的不良预后和临床病理侵袭性相关。
