Emphysema phenotypes and lung cancer risk

PLoS One. 2019 Jul 25;14(7):e0219187. doi: 10.1371/journal.pone.0219187. eCollection 2019.

Abstract

Background: To assess the relationship between lung cancer and emphysema subtypes.

Objective: Airflow obstruction and emphysema predispose to lung cancer. Little is known, however, about the lung cancer risk associated with different emphysema phenotypes. We assessed the risk of lung cancer based on the presence, type and severity of emphysema, using visual assessment.

Methods: Seventy-two consecutive lung cancer cases were selected from a prospective cohort of 3,477 participants enrolled in the Clínica Universidad de Navarra's lung cancer screening program. Each case was matched to three control subjects using age, sex, smoking history and body mass index as key variables. Visual assessment of emphysema and spirometry were performed. Logistic regression and interaction model analysis were used in order to investigate associations between lung cancer and emphysema subtypes.

Results: Airflow obstruction and visual emphysema were significantly associated with lung cancer (OR = 2.8, 95%CI: 1.6 to 5.2; OR = 5.9, 95%CI: 2.9 to 12.2; respectively). Emphysema severity and centrilobular subtype were associated with greater risk when adjusted for confounders (OR = 12.6, 95%CI: 1.6 to 99.9; OR = 34.3, 95%CI: 25.5 to 99.3, respectively). The risk of lung cancer decreases with the added presence of paraseptal emphysema (OR = 4.0, 95%CI: 3.6 to 34.9), losing this increased risk of lung cancer when it occurs alone (OR = 0.7, 95%CI: 0.5 to 2.6).

Conclusions: Visual scoring of emphysema predicts lung cancer risk. The centrilobular phenotype is associated with the greatest risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Emphysema / pathology*
  • Female
  • Humans
  • Logistic Models
  • Lung Neoplasms / etiology*
  • Male
  • Middle Aged
  • Models, Biological
  • Multivariate Analysis
  • Odds Ratio
  • Phenotype
  • Risk Factors

Associated data

  • figshare/10.6084/m9.figshare.8046461.v1

Grants and funding

This work was supported in part by a grant [RD12/0036/0062 and RD12/0036/0040] from Red Tematica de Investigacion Cooperativa en Cancer, Instituto de Salud Carlos III, the Spanish Ministry of Economy and Competitiveness and European Regional Development Fund “Una manera de hacer Europa.” It was also supported by grants PI04/2404, PI07/0792, PI10/01652, and PI11/01626 from the Instituto de Salud Carlos III, Ministry of Economy and Competitiveness, Government of Spain. The funder provided support in the form of salaries for authors [JJZ, JPd-T, DY, CH, AR]. The specific roles of these authors are articulated in the author contributions section. Funding agencies were not involved in study design, data collection nor analysis, decision to publish, or preparation of the manuscript.