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Original Research: COPD |

Are Airflow Obstruction and Radiographic Evidence of Emphysema Risk Factors for Lung Cancer?: A Nested Case-Control Study Using Quantitative Emphysema Analysis

Fabien Maldonado, MD; Brian J. Bartholmai, MD; Stephen J. Swensen, MD; David E. Midthun, MD, FCCP; Paul A. Decker, MS; James R. Jett, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Drs Maldonado, Midthun, and Jett), Division of Radiology (Drs Bartholmai and Swensen), and Division of Biostatistics (Mr Decker), Mayo Clinic, Rochester, MN.

Correspondence to: Fabien Maldonado, MD, Division of Pulmonary and Critical Care Medicine, Gonda 18 South, Mayo Clinic, 200 1st St SW, Rochester, MN 55905; e-mail: Maldonado.Fabien@mayo.edu


For editorial comment see page 1289

Funding/Support: This study was funded by the Mayo Clinic Foundation and the Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(6):1295-1302. doi:10.1378/chest.09-2567
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Objectives:  Several studies have identified airflow obstruction as a risk factor for lung cancer independent of smoking history, but the risk associated with the presence of radiographic evidence of emphysema has not been extensively studied. We proposed to assess this risk using a quantitative volumetric CT scan analysis.

Methods:  Sixty-four cases of lung cancer were identified from a prospective cohort of 1,520 participants enrolled in a spiral CT scan lung cancer screening trial. Each case was matched to six control subjects for age, sex, and smoking history. Quantitative CT scan analysis of emphysema was performed. Spirometric measures were also conducted. Data were analyzed using conditional logistic regression making use of the 1:6 set groups of 64 cases and 377 matched control subjects.

Results:  Decreased FEV1 and FEV1/FVC were significantly associated with a diagnosis of lung cancer with ORs of 1.15 (95% CI, 1.00-1.32; P = .046) and 1.29 (95% CI, 1.02-1.62; P = .031), respectively. The quantity of radiographic evidence of emphysema was not found to be a significant risk for lung cancer with OR of 1.042 (95% CI, 0.816-1.329; P = .743). Additionally, there was no significant association between severe emphysema and lung cancer with OR of 1.57 (95% CI, 0.73-3.37).

Conclusions:  We confirm previous observations that airflow obstruction is an independent risk factor for lung cancer. The absence of a clear relationship between radiographic evidence of emphysema and lung cancer using an automated quantitative volumetric analysis may result from different population characteristics than those of prior studies, radiographic evidence of emphysema quantitation methodology, or absence of any relationship between emphysema and lung cancer risk.

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