PT - JOURNAL ARTICLE AU - Yixiao Zhang AU - Jiawen Yi AU - Dan Sun AU - Yanping Su AU - Yingting Zuo AU - Min Zhu AU - Shu Zhang AU - Kewu Huang AU - Xiaojuan Guo AU - Yuhui Zhang TI - The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer AID - 10.1183/23120541.00195-2023 DP - 2023 Nov 01 TA - ERJ Open Research PG - 00195-2023 VI - 9 IP - 6 4099 - http://openres.ersjournals.com/content/9/6/00195-2023.short 4100 - http://openres.ersjournals.com/content/9/6/00195-2023.full SO - erjor2023 Nov 01; 9 AB - Background Although computed tomography (CT)-defined emphysema is considered a predictor of lung cancer risk, it is not fully clear whether CT-defined emphysema is associated with the prognosis of lung cancer. We aimed to assess the clinical impact of CT-defined emphysema on the survival of lung cancer.Methods In the prospective cohort study of nonsmall cell lung cancer (NSCLC), the correlation between CT-defined emphysema and clinical variables was analysed. A multivariable Cox regression model was built to assess the association between CT-defined emphysema and overall survival (OS) for up to 8.8 years. The differences in survival analyses were derived by Kaplan–Meier analysis and log-rank testing. Low attenuation area (LAA%) was defined as the per cent of voxels below −950 HU.Results 854 patients were included and CT-defined emphysema was present in 300 (35.1%) at diagnosis. Epidermal growth factor receptor (EGFR) wild-type (OR 1.998; p<0.001) and anaplastic lymphoma kinase (ALK) wild-type (OR 2.277; p=0.004) were associated with CT-defined emphysema. CT-defined emphysema remained a significant predictor of prognosis adjusting for age, sex, smoking history, tumour histology and Eastern Cooperative Oncology Group Performance Status (ECOG PS), whether in I-IIIA stage (adjusted hazard ratio (HR) 1.745; p=0.017) or in IIIB-IV stage (adjusted HR 1.291; p=0.022). Stratified analyses showed that OS rate among the driver oncogene groups with different CT-defined emphysema status differed significantly (log-rank p<0.001). Furthermore, patients with centrilobular emphysema (CLE) with LAA% >17% displayed poorer survival than those with LAA% ≤17% (median 432 versus 670 days; HR 1.564; p=0.020).Conclusions CT-defined emphysema, especially CLE with LAA%>17%, is an independent predictor of NSCLC prognosis. Moreover, prospective studies are needed to further explore this association.Computed tomography (CT)-defined emphysema is often considered a predictor of lung cancer risk. This prospective cohort study adds that CT-defined emphysema is significantly associated with worse survival, regardless of oncogene status or tumour stage. https://bit.ly/3Phnwse