RT Journal Article
SR Electronic
T1 The association of chest computed tomography-defined visual emphysema and prognosis in patients with nonsmall cell lung cancer
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00195-2023
DO 10.1183/23120541.00195-2023
VO 9
IS 6
A1 Zhang, Yixiao
A1 Yi, Jiawen
A1 Sun, Dan
A1 Su, Yanping
A1 Zuo, Yingting
A1 Zhu, Min
A1 Zhang, Shu
A1 Huang, Kewu
A1 Guo, Xiaojuan
A1 Zhang, Yuhui
YR 2023
UL https://publications.ersnet.org//content/9/6/00195-2023.abstract
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