SESSION TITLE: Decision-Making in Lung Cancer
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Wednesday, October 30, 2013 at 07:30 AM - 09:00 AM
PURPOSE: Emphysema is known to be an independent risk factor for the development of lung cancer. However, it is not known whether lung cancers develop in the regions of worse emphysema within individual patients. Therefore, we studied the association between the degree of regional emphysema as scored on CT scanning and development of primary lung cancer.
METHODS: We conducted a database review using the first collection period of the NIH Lung Tissue Research Consortium to identify lung cancers in those with and without COPD. Utilizing database CT scans, the location of each lung cancer (categorized as right/left, upper/middle/lower, and central/peripheral) was extracted and compared to regional emphysema scores (also categorized as above). Regional emphysema scores were scored by chest radiologists according the NETT guidelines. Conditional logistic regression, taking into account repeated measurements for each individual, was used to analyze the association between lung cancer location and regional emphysema scores.
RESULTS: Of 1215 records available, 723 had a diagnosis of primary lung cancer (small cell or non-small cell). Of those, 623 had sufficient data for regional emphysema score analysis. Among these 623, lung cancers were more likely to develop on the right side (vs. left, p< 0.001), in the upper lobe (vs. middle or lower, p=0.0093), and in the peripheral region of the lobe (vs. central, p< 0.001). The most common location of lung cancer was in the right upper peripheral region (171/623, 27%). When comparing the location of lung cancer development to the lung regions without malignancy, the odds of having a lung cancer were increased with higher emphysema scores OR=1.3 (95% CI 1.1-1.6; p=0.002).
CONCLUSIONS: Among patients with primary lung cancer, cancers are more likely to develop in areas of worse regional emphysema. These findings suggest that regional emphysema provides a tissue substrate favorable for the development of malignancy.
CLINICAL IMPLICATIONS: The data suggest regional emphysema may contribute to the development of primary lung cancer.
DISCLOSURE: The following authors have nothing to disclose: Laurie Hohberger, Darrell Schroeder, Brian Bartholmai, Ping Yang, Christine Wendt, Peter Bitterman, Andrew Limper
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