Visual scoring of emphysema is predictive of an individual’s risk for lung cancer, with the centrilobular emphysema phenotype associated with the greatest risk, according to an analysis published in PLoS One.
Researchers of a prospective cohort study, which was conducted at the Clínica Universidad de Navarra in Pamplona, Spain, examined the relationship among lung cancer risk, airflow obstruction, and emphysema phenotype/severity with the use of widely accepted visual scoring methods.
Recognizing that airflow obstruction and emphysema predispose individuals to lung cancer, the researchers explored the risk for lung cancer based on the presence, type, and severity of emphysema with the use of visual assessment. A total of 72 consecutive cases of lung cancer were chosen from a cohort of 3477 participants. Each of the cases was matched to 3 control participants for sex, age, body mass index, and smoking history. The visual assessment of emphysema and spirometry were conducted.
Study results demonstrated that airflow obstruction and visual emphysema were significantly associated with lung cancer (odds ratio [OR], 2.85; 95% CI, 1.56-5.21 and OR, 5.94; 95% CI, 2.90-12.17, respectively). When adjusted for confounders, emphysema severity and centrilobular emphysema phenotype were associated with a greater risk for lung cancer (OR, 12.5; 95% CI, 1.6-99.9 and OR, 34.27; 95% CI, 25.48-99.31, respectively). Moreover, the risk for lung cancer declined with the additional presence of paraseptal emphysema (OR, 4.0; 95% CI, 3.6-34.9), with this elevated lung cancer risk not observed when paraseptal emphysema occurred alone (OR, 0.68; 95% CI, 0.54-2.64).
A major study limitation is that there were more active smokers in the group with lung cancer compared with the control group. Another limitation may be the predominance of men in the study, which is a key factor, because women have demonstrated less radiographic evidence of emphysema compared with men.
The investigators concluded that visually evaluated centrilobular emphysema, not paraseptal emphysema, is linked to an increased risk for lung cancer. These study findings may have implications for lung cancer screening and patient follow-up.
González J, Henschke CI, Yankelevitz DF, et al. Emphysema phenotypes and lung cancer risk. PLoS One. 2019;14(7):e0219187.