1
|
Zhu L, Liu J, Zeng L, Moonindranath S, An P, Chen H, Xiang Q, Wang Z. Thoracic high resolution computed tomography evaluation of imaging abnormalities of 108 lung cancer patients with different pulmonary function. Cancer Imaging 2024; 24:78. [PMID: 38910260 PMCID: PMC11194896 DOI: 10.1186/s40644-024-00720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 06/10/2024] [Indexed: 06/25/2024] Open
Abstract
PURPOSE Preserved ratio impaired spirometry (PRISm) and chronic obstructive pulmonary disease (COPD) belong to lung function injury. PRISm is a precursor to COPD. We compared and evaluated the different basic information, imaging findings and survival curves of 108 lung cancer patients with different pulmonary function based on high resolution computed tomography (HRCT). METHODS This retrospective study was performed on 108 lung cancer patients who did pulmonary function test (PFT) and thoracic HRCT. The basic information was evaluated: gender, age, body mass index (BMI), smoke, smoking index (SI). The following pulmonary function findings were evaluated: forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), FEV1/FVC ratio. The following computed tomography (CT) findings were evaluated: appearance (bronchiectasis, pneumonectasis, atelectasis, ground-glass opacities [GGO], interstitial inflammation, thickened bronchial wall), diameter (aortic diameter, pulmonary artery diameter, MPAD/AD ratio, inferior vena cava diameter [IVCD]), tumor (volume, classification, distribution, staging [I, II, III, IV]). Mortality rates were calculated and survival curves were estimated using the Kaplan-Meier method. RESULTS Compared with normal pulmonary function group, PRISm group and COPD group were predominantly male, older, smoked more, poorer lung function and had shorter survival time after diagnosis. There were more abnormal images in PRISm group and COPD group than in normal lung function group (N-C group). In PRISm group and COPD group, lung cancer was found late, and the tumor volume was larger, mainly central squamous carcinoma. But the opposite was true for the N-C group. The PRISm group and COPD group had significant poor survival probability compared with the normal lung function group. CONCLUSIONS Considerable differences regarding basic information, pulmonary function, imaging findings and survival curves are found between normal lung function group and lung function injury group. Lung function injury (PRISm and COPD) should be taken into account in future lung cancer screening studies.
Collapse
Affiliation(s)
- Li Zhu
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Jiali Liu
- School of Public Health, Southeast University, No. 2 Sipai Lou, Nanjing, 210096, China
| | - Liang Zeng
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | | | - Peng An
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Hu Chen
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China
| | - Quanyong Xiang
- School of Public Health, Southeast University, No. 2 Sipai Lou, Nanjing, 210096, China.
- Department of Chronic Non-communicable Disease Control, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China.
| | - Zhongqiu Wang
- Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing, 210029, China.
| |
Collapse
|
2
|
Kyaw TW, Tsai MK, Wen CP, Shu CC, Su TC, Wu X, Gao W. Impaired lung function and lung cancer risk in 461 183 healthy individuals: a cohort study. BMJ Open Respir Res 2024; 11:e001936. [PMID: 38719501 PMCID: PMC11086288 DOI: 10.1136/bmjresp-2023-001936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 03/15/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND It has been known that smoking and various lung diseases including lung cancer can cause lung function impairment. However, the impact of different types of lung function impairments, such as preserved ratio impaired spirometry (PRISm) and airflow obstruction (AO), on the incidence and mortality of lung cancer in both general and never-smoker populations remains unclear. We wished to examine the effect of lung function impairments on lung cancer risks. METHODS This was a retrospective cohort study (1 January 1994 to 31 December 2017) of individuals from a health surveillance programme in Taiwan who underwent baseline spirometry tests at the entry point. PRISm was defined as an FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) ratio >0.7 and FEV1 <0.8, while AO was defined as an FEV1/FVC ratio <0.7. Cox proportional hazards models and cubic spline curves were used to examine the associations between lung function impairments and lung cancer risks. RESULTS The study included 461,183 individuals, of whom 14.3% had PRISm and 7.9% had AO. A total of 4038 cases of lung cancer and 3314 lung cancer-related deaths were identified during the 23 years of follow-up. Individuals with PRISm and AO exhibited a higher risk of lung cancer incidence and mortality compared with those with normal lung function. The adjusted HRs and 95% CIs were 1.14 (1.03 to 1.26) and 1.23 (1.10 to 1.37) in the overall cohort, and 1.08 (0.93 to 1.24), and 1.23 (1.05 to 1.45) in the never-smoker cohort. The risks of both developing and dying of lung cancer increased with the severity levels of lung function impairments and lower FEV1 values. CONCLUSION Impaired lung function is associated with increased risks of developing lung cancer and subsequent mortality. The study highlights the importance of considering lung function in lung cancer screening for better candidate selection.
Collapse
Affiliation(s)
- Thu Win Kyaw
- Global Health and Health Security Program, School of Public Health, Taipei Medical University College of Public Health and Nutrition, Taipei, Taiwan
| | - Min-Kuang Tsai
- Global Health and Health Security Program, School of Public Health, Taipei Medical University College of Public Health and Nutrition, Taipei, Taiwan
| | - Chi Pang Wen
- National Health Research Institutes, Zhunan, Taiwan
| | - Chin-Chung Shu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- National Taiwan University, Taipei, Taiwan
| | - Ta-Chen Su
- Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Xifeng Wu
- School of Public Health, Zhejiang Medical University, Hangzhou, China
| | - Wayne Gao
- Global Health and Health Security Program, School of Public Health, Taipei Medical University College of Public Health and Nutrition, Taipei, Taiwan
| |
Collapse
|
3
|
Yu Z, Xie G, Qin C, He H, Wei Q. Effect of postoperative exercise training on physical function and quality of life of lung cancer patients with chronic obstructive pulmonary disease: A randomized controlled trial. Medicine (Baltimore) 2024; 103:e37285. [PMID: 38457572 PMCID: PMC10919482 DOI: 10.1097/md.0000000000037285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Postoperative rehabilitation programs consisting of exercise training are considered effective for unselected lung cancer patients. However, whether postoperative exercise is beneficial to lung cancer patients comorbid with chronic obstructive pulmonary disease remains unknown. METHODS Eighty-four patients diagnosed with both lung cancer and chronic obstructive pulmonary disease were randomized into the exercise group and control group. Both groups were given standard postoperative rehabilitation for 1 week. After that, oxygen therapy (if needed) and nebulization were given to the control group, while patients in the exercise group started to participate in exercise programs on the basis of receiving oxygen therapy and nebulization as in the control group. The exercise programs consisted of 24 training sessions. RESULTS In both groups, the functional status and the results of the pulmonary function test decreased from baseline to the endpoint. However, after surgery and the intervention program, both the maximal oxygen consumption in the cardiopulmonary exercise test and walking distance in the 6-minute walk test in the exercise group were significantly better than those in the control group [15.5 (±1.4) mL/kg/min vs 13.1 (±1.3) mL/kg/min, P = 0.016; 437.4 (±48.6) m vs 381.7 (±40.5) m, P = 0.040]. Force vital capacity and forced expiratory volume in the first second in the exercise group were better than those in the control group, but the differences were not statistically significant [1798.1 (±298.9) mL vs 1664.0 (±329.7) mL, P = 0.254; 1155.7 (±174.3) mL vs 967.4 (±219.4) mL, P = 0.497]. The decline in the standard score of the QLQ-C30 (V3.0) was smaller in the exercise group, but the difference did not meet a statistically significant level [61.7 (±5.7) vs 58.4 (±9.3), P = 0.318]. CONCLUSION This study demonstrates that a short-term postoperative exercise training program can facilitate the recovery of functional capacity in lung cancer patients with comorbidities of chronic obstructive pulmonary disease.
Collapse
Affiliation(s)
- Zhonghua Yu
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Guosheng Xie
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Changlong Qin
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, Sichuan, PR China
| | - Hongchen He
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Quan Wei
- Department of Rehabilitation Medicine and Institute of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| |
Collapse
|
4
|
Zuo W, Li J, Zuo M, Li M, Zhou S, Cai X. Prediction of the benign and malignant nature of masses in COPD background based on Habitat-based enhanced CT radiomics modeling: A preliminary study. Technol Health Care 2024:THC231980. [PMID: 38517821 DOI: 10.3233/thc-231980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
BACKGROUND It is difficult to differentiate between chronic obstructive pulmonary disease (COPD)-peripheral bronchogenic carcinoma (COPD-PBC) and inflammatory masses. OBJECTIVE This study aims to predict COPD-PBC based on clinical data and preoperative Habitat-based enhanced CT radiomics (HECT radiomics) modeling. METHODS A retrospective analysis was conducted on clinical imaging data of 232 cases of postoperative pathological confirmed PBC or inflammatory masses. The PBC group consisted of 82 cases, while the non-PBC group consisted of 150 cases. A training set and a testing set were established using a 7:3 ratio and a time cutoff point. In the training set, multiple models were established using clinical data and radiomics texture changes within different enhanced areas of the CT mass (HECT radiomics). The AUC values of each model were compared using Delong's test, and the clinical net benefit of the models was tested using decision curve analysis (DCA). The models were then externally validated in the testing set, and a nomogram of predicting COPD-PBC was created. RESULTS Univariate analysis confirmed that female gender, tumor morphology, CEA, Cyfra21-1, CT enhancement pattern, and Habitat-Radscore B/C were predictive factors for COPD-PBC (P< 0.05). The combination model based on these factors had significantly higher predictive performance [AUC: 0.894, 95% CI (0.836-0.936)] than the clinical data model [AUC: 0.758, 95% CI (0.685-0.822)] and radiomics model [AUC: 0.828, 95% CI (0.761-0.882)]. DCA also confirmed the higher clinical net benefit of the combination model, which was validated in the testing set. The nomogram developed based on the combination model helped predict COPD-PBC. CONCLUSION The combination model based on clinical data and Habitat-based enhanced CT radiomics can help differentiate COPD-PBC, providing a new non-invasive and efficient method for its diagnosis, treatment, and clinical decision-making.
Collapse
Affiliation(s)
- Wanzhao Zuo
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Jing Li
- Department of Respiratory Medicine, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang Institute of Traditional Chinese Medicine, Xiangyang, Hubei, China
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Mingyan Zuo
- Department of Respiratory Medicine, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang Institute of Traditional Chinese Medicine, Xiangyang, Hubei, China
- College of Traditional Chinese Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei, China
| | - Miao Li
- Department of Respiratory Medicine, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang Institute of Traditional Chinese Medicine, Xiangyang, Hubei, China
| | - Shuang Zhou
- Department of Respiratory Medicine, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang Institute of Traditional Chinese Medicine, Xiangyang, Hubei, China
| | - Xing Cai
- Department of Respiratory Medicine, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang Institute of Traditional Chinese Medicine, Xiangyang, Hubei, China
| |
Collapse
|
5
|
Zhang X, Zeng J, Huang X, Li Z. When chronic obstructive pulmonary disease meets small cell lung cancer: an unusual case report of rapid progression. BMC Geriatr 2023; 23:836. [PMID: 38082430 PMCID: PMC10714477 DOI: 10.1186/s12877-023-04508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease and a risk factor for lung cancer. Small cell lung cancer is a neuroendocrine tumor with a high degree of malignancy and an overall five-year survival rate of less than 7%. CASES PRESENTATION Herein, we report the case of an 68-year-old male presented to the respiratory department with cough, sputum, and dyspnea. He was diagnosed as community acquired pneumonia and treated with intravenous anti-infection. Previous pulmonary function was definitively diagnosed as COPD. About 7 months after discharge, the patient returned to the hospital for cough and dyspnea. After diagnosis of the tumor, cisplatin, etoposide and durvalumab were administered. Finally the patient died of respiratory failure approximately 9 months after his diagnosis. CONCLUSIONS For COPD patients with immunocompromised manifestations, it is necessary to be alert to complications and shorten the follow-up interval of chest CT. COPD may accelerate the formation and progression of SCLC.
Collapse
Affiliation(s)
- Xu Zhang
- Department of Respiratory and Critical Care Medicine, Guangyuan Central Hospital, 10 Lianhua Road, Lizhou District, Guangyuan City, 628000, Sichuan Province, China
| | - Jia Zeng
- Department of Respiratory and Critical Care Medicine, Guangyuan Central Hospital, 10 Lianhua Road, Lizhou District, Guangyuan City, 628000, Sichuan Province, China
| | - Xiyu Huang
- Sichuan Academy of Medical Sciences, Cardiac Surgery Center, Sichuan Provincial People's Hospital, Chengdu, 610000, China
| | - Zhishu Li
- Department of Respiratory and Critical Care Medicine, Guangyuan Central Hospital, 10 Lianhua Road, Lizhou District, Guangyuan City, 628000, Sichuan Province, China.
- Department of Respiratory and Critical Care Medicine, Tianjin Medical University General Hospital, Tianjin, 300000, China.
| |
Collapse
|
6
|
Crapo JD, Gupta A, Lynch DA, Turner AM, Mroz RM, Janssens W, Ludwig-Sengpiel A, Koegler H, Eleftheraki A, Risse F, Diefenbach C. Baseline characteristics from a 3-year longitudinal study to phenotype subjects with COPD: the FOOTPRINTS study. Respir Res 2023; 24:290. [PMID: 37978492 PMCID: PMC10656819 DOI: 10.1186/s12931-023-02584-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND FOOTPRINTS® is a prospective, longitudinal, 3-year study assessing the association between biomarkers of inflammation/lung tissue destruction and chronic obstructive pulmonary disease (COPD) severity and progression in ex-smokers with mild-to-severe COPD. Here, we present baseline characteristics and select biomarkers of study subjects. METHODS The methodology of FOOTPRINTS® has been published previously. The study population included ex-smokers with a range of COPD severities (Global Initiative for Chronic Obstructive Lung Disease [GOLD] stages 1-3), ex-smokers with COPD and alpha-1-antitrypsin deficiency (A1ATD) and a control group of ex-smokers without airflow limitation (EwAL). At study entry, data were collected for: demographics, disease characteristics, history of comorbidities and COPD exacerbations, symptoms, lung function and volume, exercise capacity, soluble biomarkers, and quantitative and qualitative computed tomography. Baseline data are presented with descriptive statistical comparisons for soluble biomarkers in the individual GOLD and A1ATD groups versus EwAL. RESULTS In total, 463 subjects were enrolled. The per-protocol set comprised 456 subjects, mostly male (64.5%). The mean (standard deviation) age was 60.7 (6.9) years. At baseline, increasing pulmonary symptoms, worse lung function, increased residual volume, reduced diffusing capacity of the lung for carbon monoxide (DLco) and greater prevalence of centrilobular emphysema were observed with increasing disease severity amongst GOLD 1-3 subjects. Subjects with A1ATD (n = 19) had similar lung function parameters to GOLD 2-3 subjects, a high residual volume comparable to GOLD 3 subjects, and similar air trapping to GOLD 2 subjects. Compared with EwAL (n = 61), subjects with A1ATD had worse lung function, increased residual volume, reduced DLco, and a greater prevalence of confluent or advanced destructive emphysema. The soluble inflammatory biomarkers white blood cell count, fibrinogen, high-sensitivity C-reactive protein and plasma surfactant protein were higher in GOLD 1-3 groups than in the EwAL group. Interleukin-6 was expressed less often in EwAL subjects compared with subjects in the GOLD and A1ATD groups. Soluble receptor for advanced glycation end product was lowest in GOLD 3 subjects, indicative of more severe emphysema. CONCLUSIONS These findings provide context for upcoming results from FOOTPRINTS®, which aims to establish correlations between biomarkers and disease progression in a representative COPD population. TRIAL REGISTRATION NUMBER NCT02719184, study start date 13/04/2016.
Collapse
Affiliation(s)
- James D Crapo
- Department of Medicine, National Jewish Health, Denver, CO, USA.
| | - Abhya Gupta
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Biberach an Der Riss, Germany
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA
| | - Alice M Turner
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Robert M Mroz
- 2nd Department of Lung Diseases and Tuberculosis, Bialystok Medical University, Bialystok, Poland
| | - Wim Janssens
- Department of Chronic Diseases and Metabolism (CHROMETA), Laboratory of Respiratory Diseases and Thoracic Surgery (BREATH), University Hospital Leuven, Louvain, KU, Belgium
| | | | - Harald Koegler
- TA Inflammation Medicine, Boehringer Ingelheim International GmbH, Ingelheim, Germany
| | - Anastasia Eleftheraki
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Frank Risse
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| | - Claudia Diefenbach
- Department of Translational Medicine and Clinical Pharmacology, Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an Der Riss, Germany
| |
Collapse
|
7
|
Li B, Zhang J, Dong H, Feng X, Yu L, Zhu J, Zhang J. Systematic analysis of various RNA transcripts and construction of biological regulatory networks at the post-transcriptional level for chronic obstructive pulmonary disease. J Transl Med 2023; 21:790. [PMID: 37936118 PMCID: PMC10631086 DOI: 10.1186/s12967-023-04674-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Although chronic inflammation, oxidative stress, airway remodeling, and protease-antiprotease imbalance have been implicated in chronic obstructive pulmonary disease (COPD), the exact pathogenesis is still obscure. Gene transcription and post-transcriptional regulation have been taken into account as key regulators of COPD occurrence and development. Identifying the hub genes and constructing biological regulatory networks at the post-transcriptional level will help extend current knowledge on COPD pathogenesis and develop potential drugs. METHODS All lung tissues from non-smokers (n = 6), smokers without COPD (smokers, n = 7), and smokers with COPD (COPD, n = 7) were collected to detect messenger RNA (mRNA), microRNA (miRNA), circular RNA (circRNA), and long non-coding RNA (lncRNA) expression and identify the hub genes. Biological regulatory networks were constructed at the post-transcriptional level, including the RNA-binding protein (RBP)-hub gene interaction network and the competitive endogenous RNA (ceRNA) network. In addition, we assessed the composition and abundance of immune cells in COPD lung tissue and predicted potential therapeutic drugs for COPD. Finally, the hub genes were confirmed at both the RNA and protein levels. RESULTS Among the 20 participants, a total of 121169 mRNA transcripts, 1871 miRNA transcripts, 4244 circRNA transcripts, and 122130 lncRNA transcripts were detected. There were differences in the expression of 1561 mRNAs, 48 miRNAs, 33 circRNAs, and 545 lncRNAs between smokers and non-smokers, as well as 1289 mRNAs, 69 miRNAs, 32 circRNAs, and 433 lncRNAs between smokers and COPD patients. 18 hub genes were identified in COPD. TGF-β signaling and Wnt/β-catenin signaling may be involved in the development of COPD. Furthermore, the circRNA/lncRNA-miRNA-mRNA ceRNA networks and the RBP-hub gene interaction network were also constructed. Analysis of the immune cell infiltration level revealed that M2 macrophages and activated NK cells were increased in COPD lung tissues. Finally, we identified that the ITK inhibitor and oxybutynin chloride may be effective in treating COPD. CONCLUSIONS We identified several novel hub genes involved in COPD pathogenesis. TGF-β signaling and Wnt/β-catenin signaling were the most dysregulated pathways in COPD patients. Our study constructed post-transcriptional biological regulatory networks and predicted small-molecule drugs for the treatment of COPD, which enhanced the existing understanding of COPD pathogenesis and suggested an innovative direction for the therapeutic intervention of the disease.
Collapse
Affiliation(s)
- Beibei Li
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, China
| | - Jiajun Zhang
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, China
| | - Hui Dong
- Center of Research Equipment Management, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xueyan Feng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, 750004, China
| | - Liang Yu
- Department of Thoracic Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Jinyuan Zhu
- Department of Critical Care Medicine, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Jin Zhang
- Department of Respiratory and Critical Care Medicine, General Hospital of Ningxia Medical University, 804 Shengli South Street, Xingqing District, Yinchuan, 750004, China.
| |
Collapse
|
8
|
Dezzani EO. Pneumological problems in surgical practice. Minerva Surg 2023; 78:469-480. [PMID: 37870534 DOI: 10.23736/s2724-5691.23.10122-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
|
9
|
Zhuan B, Ma HH, Zhang BC, Li P, Wang X, Yuan Q, Yang Z, Xie J. Identification of non-small cell lung cancer with chronic obstructive pulmonary disease using clinical symptoms and routine examination: a retrospective study. Front Oncol 2023; 13:1158948. [PMID: 37576878 PMCID: PMC10419203 DOI: 10.3389/fonc.2023.1158948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 07/03/2023] [Indexed: 08/15/2023] Open
Abstract
Background Patients with non-small cell lung cancer (NSCLC) and patients with NSCLC combined with chronic obstructive pulmonary disease (COPD) have similar physiological conditions in early stages, and the latter have shorter survival times and higher mortality rates. The purpose of this study was to develop and compare machine learning models to identify future diagnoses of COPD combined with NSCLC patients based on the patient's disease and routine clinical data. Methods Data were obtained from 237 patients with COPD combined with NSCLC as well as NSCLC admitted to Ningxia Hui Autonomous Region People's Hospital from October 2013 to July 2022. Six machine learning algorithms (K-nearest neighbor, logistic regression, eXtreme gradient boosting, support vector machine, naïve Bayes, and artificial neural network) were used to develop prediction models for NSCLC combined with COPD. Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, F1 score, Mathews correlation coefficient (MCC), Kappa, area under the receiver operating characteristic curve (AUROC)and area under the precision-recall curve (AUPRC) were used as performance indicators to evaluate the performance of the models. Results 135 patients with NSCLC combined with COPD, 102 patients with NSCLC were included in the study. The results showed that pulmonary function and emphysema were important risk factors and that the support vector machine-based identification model showed optimal performance with accuracy:0.946, recall:0.940, specificity:0.955, precision:0.972, npv:0.920, F1 score:0.954, MCC:0.893, Kappa:0.888, AUROC:0.975, AUPRC:0.987. Conclusion The use of machine learning tools combining clinical symptoms and routine examination data features is suitable for identifying the risk of concurrent NSCLC in COPD patients.
Collapse
Affiliation(s)
- Bing Zhuan
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan, Ningxia, China
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital Affiliated to Ningxia Medical University, Yinchuan, Ningxia, China
| | - Hong-Hong Ma
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan, Ningxia, China
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital Affiliated to Ningxia Medical University, Yinchuan, Ningxia, China
| | - Bo-Chao Zhang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Suzhou, Jiangsu, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Ping Li
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital, Yinchuan, Ningxia, China
- Department of Respiratory Medicine, Ningxia Hui Autonomous Region People’s Hospital Affiliated to Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xi Wang
- Department of Respiratory Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Qun Yuan
- Department of Respiratory Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Zhao Yang
- Department of Respiratory Medicine, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| | - Jun Xie
- Department of Thoracic Surgery, Affiliated Suzhou Science and Technology Town Hospital of Nanjing Medical University, Suzhou, Jiangsu, China
| |
Collapse
|
10
|
Li TZ, Hin Lee H, Xu K, Gao R, Dawant BM, Maldonado F, Sandler KL, Landman BA. Quantifying emphysema in lung screening computed tomography with robust automated lobe segmentation. J Med Imaging (Bellingham) 2023; 10:044002. [PMID: 37469854 PMCID: PMC10353481 DOI: 10.1117/1.jmi.10.4.044002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 06/14/2023] [Accepted: 06/21/2023] [Indexed: 07/21/2023] Open
Abstract
Purpose Anatomy-based quantification of emphysema in a lung screening cohort has the potential to improve lung cancer risk stratification and risk communication. Segmenting lung lobes is an essential step in this analysis, but leading lobe segmentation algorithms have not been validated for lung screening computed tomography (CT). Approach In this work, we develop an automated approach to lobar emphysema quantification and study its association with lung cancer incidence. We combine self-supervised training with level set regularization and finetuning with radiologist annotations on three datasets to develop a lobe segmentation algorithm that is robust for lung screening CT. Using this algorithm, we extract quantitative CT measures for a cohort (n = 1189 ) from the National Lung Screening Trial and analyze the multivariate association with lung cancer incidence. Results Our lobe segmentation approach achieved an external validation Dice of 0.93, significantly outperforming a leading algorithm at 0.90 (p < 0.01 ). The percentage of low attenuation volume in the right upper lobe was associated with increased lung cancer incidence (odds ratio: 1.97; 95% CI: [1.06, 3.66]) independent of PLCO m 2012 risk factors and diagnosis of whole lung emphysema. Quantitative lobar emphysema improved the goodness-of-fit to lung cancer incidence (χ 2 = 7.48 , p = 0.02 ). Conclusions We are the first to develop and validate an automated lobe segmentation algorithm that is robust to smoking-related pathology. We discover a quantitative risk factor, lending further evidence that regional emphysema is independently associated with increased lung cancer incidence. The algorithm is provided at https://github.com/MASILab/EmphysemaSeg.
Collapse
Affiliation(s)
- Thomas Z. Li
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, School of Medicine, Nashville, Tennessee, United States
| | - Ho Hin Lee
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
| | - Kaiwen Xu
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | - Riqiang Gao
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
| | - Benoit M. Dawant
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
| | - Fabien Maldonado
- Vanderbilt University Medical Center, Department of Medicine, Nashville, Tennessee, United States
| | - Kim L. Sandler
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
| | - Bennett A. Landman
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States
- Vanderbilt University, Department of Computer Science, Nashville, Tennessee, United States
- Vanderbilt University, Department of Electrical and Computer Engineering, Nashville, Tennessee, United States
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, Tennessee, United States
| |
Collapse
|
11
|
Raoof S, Shah M, Make B, Allaqaband H, Bowler R, Fernando S, Greenberg H, Han MK, Hogg J, Humphries S, Lee KS, Lynch D, Machnicki S, Mehta A, Mina B, Naidich D, Naidich J, Naqvi Z, Ohno Y, Regan E, Travis WD, Washko G, Braman S. Lung Imaging in COPD Part 1: Clinical Usefulness. Chest 2023; 164:69-84. [PMID: 36907372 PMCID: PMC10403625 DOI: 10.1016/j.chest.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/23/2023] [Accepted: 03/04/2023] [Indexed: 03/13/2023] Open
Abstract
COPD is a condition characterized by chronic airflow obstruction resulting from chronic bronchitis, emphysema, or both. The clinical picture is usually progressive with respiratory symptoms such as exertional dyspnea and chronic cough. For many years, spirometry was used to establish a diagnosis of COPD. Recent advancements in imaging techniques allow quantitative and qualitative analysis of the lung parenchyma as well as related airways and vascular and extrapulmonary manifestations of COPD. These imaging methods may allow prognostication of disease and shed light on the efficacy of pharmacologic and nonpharmacologic interventions. This is the first of a two-part series of articles on the usefulness of imaging methods in COPD, and it highlights useful information that clinicians can obtain from these imaging studies to make more accurate diagnosis and therapeutic decisions.
Collapse
Affiliation(s)
- Suhail Raoof
- Northwell Health, Lenox Hill Hospital, New York, NY.
| | - Manav Shah
- Northwell Health, Lenox Hill Hospital, New York, NY
| | | | | | | | | | | | | | - James Hogg
- University of British Columbia, Vancouver, BC, Canada
| | | | - Kyung Soo Lee
- Sungkyunkwan University School of Medicine, Samsung ChangWon Hospital, ChangWon, South Korea
| | | | | | | | - Bushra Mina
- Northwell Health, Lenox Hill Hospital, New York, NY
| | | | | | - Zarnab Naqvi
- Northwell Health, Lenox Hill Hospital, New York, NY
| | | | | | | | | | - Sidney Braman
- Icahn School of Medicine at Mount Sinai, New York, NY
| |
Collapse
|
12
|
Tu W, Zhou T, Zhou X, Ma Y, Duan S, Wang Y, Wang X, Liu T, Zhang H, Feng Y, Huang W, Jiang X, Xiao Y, Liu S, Fan L. Nomograms Using CT Morphological Features and Clinical Characteristics to Identify COPD in Patients with Lung Cancer: A Multicenter Study. Int J Chron Obstruct Pulmon Dis 2023; 18:1169-1185. [PMID: 37332841 PMCID: PMC10275328 DOI: 10.2147/copd.s405429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 05/30/2023] [Indexed: 06/20/2023] Open
Abstract
Purpose This study aimed to screen out computed tomography (CT) morphological features and clinical characteristics of patients with lung cancer to identify chronic obstructive pulmonary disease (COPD). Further, we aimed to develop and validate different diagnostic nomograms for predicting whether lung cancer is comorbid with COPD. Patients and Methods This retrospective study examined data from 498 patients with lung cancer (280 with COPD, 218 without COPD; 349 in training cohort, 149 in validation cohort) from two centers. Five clinical characteristics and 20 CT morphological features were evaluated. Differences in all variables were assessed between COPD and non-COPD groups. Models were developed using multivariable logistic regression to identify COPD, including clinical, imaging, and combined nomograms. Receiver operating characteristic curves were used to evaluate and compare the performance of nomograms. Results Age, sex, interface, bronchus cutoff sign, spine-like process, and spiculation sign were independent predictors of COPD in patients with lung cancer. In the training and validation cohorts, the clinical nomogram showed good performance to predict COPD in lung cancer patients (areas under the curves [AUCs] of 0.807 [95% CI, 0.761-0.854] and 0.753 [95% CI, 0.674-0.832]); while the imaging nomogram showed slightly better performance (AUCs of 0.814 [95% CI, 0.770-0.858] and 0.780 [95% CI, 0.705-0.856]). For the combined nomogram generated with clinical and imaging features, the performance was further improved (AUC=0.863 [95% CI, 0.824-0.903], 0.811 [95% CI, 0.742-0.880] in the training and validation cohort). At 60% risk threshold, there were more true negative predictions (48 vs 44) and higher accuracy (73.15% vs 71.14%) for the combined nomogram compared with the clinical nomogram in the validation cohort. Conclusion The combined nomogram developed with clinical and imaging features outperformed clinical and imaging nomograms; this provides a convenient method to detect COPD in patients with lung cancer using one-stop CT scanning.
Collapse
Affiliation(s)
- Wenting Tu
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Taohu Zhou
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, 261053, People’s Republic of China
| | - Xiuxiu Zhou
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Yanqing Ma
- Department of Radiology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, 310000, People’s Republic of China
| | - Shaofeng Duan
- GE Healthcare, Precision Health Institution, Shanghai, 210000, People’s Republic of China
| | - Yun Wang
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Xiang Wang
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Tian Liu
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - HanXiao Zhang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou, Jiangsu, 221018, People’s Republic of China
| | - Yan Feng
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Wenjun Huang
- School of Medical Imaging, Weifang Medical University, Weifang, Shandong, 261053, People’s Republic of China
| | - Xinang Jiang
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Yi Xiao
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Shiyuan Liu
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| | - Li Fan
- Department of Radiology, Second Affiliated Hospital of Naval Medical University, Shanghai, 200003, People’s Republic of China
| |
Collapse
|
13
|
Polverino F, Mirra D, Yang CX, Esposito R, Spaziano G, Rojas-Quintero J, Sgambato M, Piegari E, Cozzolino A, Cione E, Gallelli L, Capuozzo A, Santoriello C, Berrino L, de- Torres JP, Hackett TL, Polverino M, D’Agostino B. Similar programmed death ligand 1 (PD-L1) expression profile in patients with mild COPD and lung cancer. Sci Rep 2022; 12:22402. [PMID: 36575294 PMCID: PMC9792927 DOI: 10.1038/s41598-022-26650-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
Programmed Death Ligand 1 (PD-L1) is crucial in regulating the immunological tolerance in non-small cell lung cancer (NSCLC). Alveolar macrophage (AM)-derived PD-L1 binds to its receptor, PD-1, on surveilling lymphocytes, leading to lymphocyte exhaustion. Increased PD-L1 expression is associated with cigarette smoke (CS)-exposure. However, the PD-L1 role in CS-associated lung diseases associated with NSCLC, such as chronic obstructive pulmonary disease (COPD), is still unclear. In two different cohorts of ever smokers with COPD or NSCLC, and ever and never smoker controls, we evaluated PD-L1 expression: (1) via cutting-edge digital spatial proteomic and transcriptomic profiling (Geomx) of formalin-fixed paraffin-embedded (FFPE) lung tissue sections (n = 19); and (2) via triple immunofluorescence staining of bronchoalveolar lavage (BAL) AMs (n = 83). PD-L1 mRNA expression was also quantified in BAL AMs exposed to CS extract. PD-L1 expression was increased in the bronchiolar wall, parenchyma, and vascular wall from mild-moderate (GOLD 1-2) COPD patients compared to severe-very severe (GOLD 3-4) COPD patients and controls. Within all the COPD patients, PD-L1 protein expression was associated with upregulation of genes involved in tumor progression and downregulation of oncosuppressive genes, and strongly directly correlated with the FEV1% predicted, indicating higher PD-L1 expression in the milder vs. more severe COPD stages. In bronchioles, PD-L1 levels were strongly directly correlated with the number of functionally active AMs. In BAL, we confirmed that AMs from patients with both GOLD 1-2 COPD and NSCLC had the highest and similar, PD-L1 expression levels versus all the other groups, independently from active cigarette smoking. Intriguingly, AMs from patients with more severe COPD had reduced AM PD-L1 expression compared to patients with mild COPD. Acute CS extract stimulation increased PD-L1 mRNA expression only in never-and not in ever-smoker AMs. Lungs from patients with mild COPD and NSCLC are characterized by a similar strong PD-L1 expression signature in bronchioles and functionally active AMs compared to patients with severe COPD and controls. Active smoking does not affect PD-L1 levels. These observations represent a new resource in understanding the innate immune mechanisms underlying the link between COPD and lung cancer onset and progression and pave the way to future studies focused on the mechanisms by which CS promotes tumorigenesis and COPD.
Collapse
Affiliation(s)
- F. Polverino
- grid.39382.330000 0001 2160 926XPulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77030 USA
| | - D. Mirra
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - C. X. Yang
- grid.17091.3e0000 0001 2288 9830University of British Columbia, Vancouver, Canada
| | - R. Esposito
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - G. Spaziano
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - J. Rojas-Quintero
- grid.39382.330000 0001 2160 926XPulmonary and Critical Care Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX 77030 USA
| | - M. Sgambato
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - E. Piegari
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - A. Cozzolino
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - E. Cione
- grid.7778.f0000 0004 1937 0319University of Calabria, Rende, Italy
| | - L. Gallelli
- grid.411489.10000 0001 2168 2547University of Catanzaro, Catanzaro, Italy
| | | | | | - L. Berrino
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - J. P. de- Torres
- grid.410356.50000 0004 1936 8331Queen’s University, Hamilton, Canada
| | - T. L. Hackett
- grid.17091.3e0000 0001 2288 9830University of British Columbia, Vancouver, Canada
| | | | - B. D’Agostino
- grid.9841.40000 0001 2200 8888University of Campania “Luigi Vanvitelli”, Caserta, Italy
| |
Collapse
|
14
|
Elicker BM. Chronic Obstructive Pulmonary Disease and Small Airways Diseases. Semin Respir Crit Care Med 2022; 43:825-838. [PMID: 36252610 DOI: 10.1055/s-0042-1755567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The small airways are a common target of injury within the lungs and may be affected by a wide variety of inhaled, systemic, and other disorders. Imaging is critical in the detection and diagnosis of small airways disease since significant injury may occur prior to pulmonary function tests showing abnormalities. The goal of this article is to describe the typical imaging findings and patterns of small airways diseases. An approach which divides the imaging appearances into four categories (tree-in-bud opacities, poorly defined centrilobular nodules, mosaic attenuation, and emphysema) will provide a framework in which to formulate appropriate and focused differential diagnoses.
Collapse
Affiliation(s)
- Brett M Elicker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California
| |
Collapse
|
15
|
Qi C, Sun SW, Xiong XZ. From COPD to Lung Cancer: Mechanisms Linking, Diagnosis, Treatment, and Prognosis. Int J Chron Obstruct Pulmon Dis 2022; 17:2603-2621. [PMID: 36274992 PMCID: PMC9586171 DOI: 10.2147/copd.s380732] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
Many studies have proved that the pathogenesis of the chronic obstructive pulmonary disease (COPD) and lung cancer is related, and may cause and affect each other to a certain extent. In fact, the change of chronic airway obstruction will continue to have an impact on the screening, treatment, and prognosis of lung cancer.In this comprehensive review, we outlined the links and heterogeneity between COPD and lung cancer and finds that factors such as gene expression and genetic susceptibility, epigenetics, smoking, epithelial mesenchymal transformation (EMT), chronic inflammation, and oxidative stress injury may all play a role in the process. Although the relationship between these two diseases have been largely determined, the methods to prevent lung cancer in COPD patients are still limited. Early diagnosis is still the key to a better prognosis. Thus, it is necessary to establish more intuitive screening evaluation criteria and find suitable biomarkers for lung cancer screening in high-risk populations with COPD. Some studies have indicated that COPD may change the efficacy of anti-tumor therapy by affecting the response of lung cancer patients to immune checkpoint inhibitors (ICIs). And for lung cancer patients with COPD, the standardized management of COPD can improve the prognosis. The treatment of lung cancer patients with COPD is an individualized, comprehensive, and precise process. The development of new targets and new strategies of molecular targeted therapy may be the breakthrough for disease treatment in the future.
Collapse
Affiliation(s)
- Chang Qi
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Sheng-Wen Sun
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Xian-Zhi Xiong
- Department of Respiratory and Critical Care Medicine, NHC Key Laboratory of Pulmonary Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China,Correspondence: Xian-Zhi Xiong, Department of Respiratory and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People’s Republic of China, Tel/Fax +86 27-85726705, Email
| |
Collapse
|
16
|
Zhao G, Li X, Lei S, Zhao H, Zhang H, Li J. Prevalence of lung cancer in chronic obstructive pulmonary disease: A systematic review and meta-analysis. Front Oncol 2022; 12:947981. [PMID: 36185264 PMCID: PMC9523743 DOI: 10.3389/fonc.2022.947981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background There is growing evidence that chronic obstructive pulmonary disease (COPD) can increase the risk of lung cancer, which poses a serious threat to treatment and management. Therefore, we performed a meta-analysis of lung cancer prevalence in patients with COPD with the aim of providing better prevention and management strategies. Methods We systematically searched PubMed, EMBASE, Web of Science, and Cochrane Library databases from their inception to 20 March 2022 to collect studies on the prevalence of lung cancer in patients with COPD. We evaluated the methodological quality of the included studies using the tool for assessing the risk of bias in prevalence studies. Meta-analysis was used to determine the prevalence and risk factors for lung cancer in COPD. Subgroup and sensitivity analyses were conducted to explore the data heterogeneity. Funnel plots combined with Egger’s test were used to detect the publication biases. Results Thirty-one studies, covering 829,490 individuals, were included to investigate the prevalence of lung cancer in patients with COPD. Pooled analysis demonstrated that the prevalence of lung cancer in patients with COPD was 5.08% (95% confidence interval [CI]: 4.17–6.00%). Subgroup analysis showed that the prevalence was 5.09% (95% CI: 3.48–6.70%) in male and 2.52% (95% CI: 1.57–4.05%) in female. The prevalence of lung cancer in patients with COPD who were current and former smokers was as high as 8.98% (95% CI: 4.61–13.35%) and 3.42% (95% CI: 1.51–5.32%); the incidence rates in patients with moderate and severe COPD were 6.67% (95% CI: 3.20–10.14%) and 5.57% (95% CI: 1.89–16.39%), respectively, which were higher than the 3.89% (95% CI: 2.14–7.06%) estimated in patients with mild COPD. Among the types of lung cancer, adenocarcinoma and squamous cell carcinoma were the most common, with incidence rates of 1.59% (95% CI: 0.23–2.94%) and 1.35% (95% CI: 0.57–3.23%), respectively. There were also differences in regional distribution, with the highest prevalence in the Western Pacific region at 7.78% (95% CI: 5.06–10.5%), followed by the Americas at 3.25% (95% CI: 0.88–5.61%) and Europe at 3.21% (95% CI: 2.36–4.06%). Conclusions This meta-analysis shows that patients with COPD have a higher risk of developing lung cancer than those without COPD. More attention should be given to this result in order to reduce the risk of lung cancer in these patients with appropriate management and prevention. Systematic review registration International prospective register of systematic reviews, identifier CRD42022331872.
Collapse
Affiliation(s)
- Guixiang Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Xuanlin Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Siyuan Lei
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
| | - Hulei Zhao
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Hailong Zhang
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Jiansheng Li
- Co-Construction Collaborative Innovation Center for Chinese Medicine and Respiratory Diseases by Henan and Education Ministry of P.R. China, Henan University of Chinese Medicine, Zhengzhou, China
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, China
- Department of Respiratory Diseases, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
- *Correspondence: Jiansheng Li,
| |
Collapse
|
17
|
Avian C, Mahali MI, Putro NAS, Prakosa SW, Leu JS. Fx-Net and PureNet: Convolutional Neural Network architecture for discrimination of Chronic Obstructive Pulmonary Disease from smokers and healthy subjects through electronic nose signals. Comput Biol Med 2022; 148:105913. [PMID: 35940164 DOI: 10.1016/j.compbiomed.2022.105913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 11/03/2022]
Abstract
As one of the most reliable and significant indicators, Chronic Obstructive Pulmonary Disease (COPD) becomes a robust predictor of lung cancer early detection, the world's leading cause of cancer death. One of the methods is to analyze the Volatile Organic Compounds (VOCs) in exhaled breath using electronic noses (E-noses), which have become emerging tools for analyzing breath because of their potential and promising technology for diagnosing. However, the signal processing of the E-Nose sensor becomes vital in exposing information about the subject condition, which most researchers strive to accomplish. We proposed a Convolutional Neural Network (CNN) architecture to classify COPD in smokers and non-smokers, healthy subjects, and smokers from E-Nose signals to contribute to this field. Two models were constructed following E-Nose signal processing state-of-the-arts. One was by combined feature extraction and classifier, and the second was by CNN, which directly processed the raw signal. In addition, various feature extraction and classifier (Machine Learning and CNN) used in prior research were investigated. Using 3K and 5K Fold cross-validation results demonstrated that our proposed models outperformed in Kernel Principal Component Analysis (KPCA) with Fx-ConvNet and Pure-ConvNet. They all reached maximum F1-Score with zero standard deviation values indicating a consistent result. Further experiments also showed that KPCA contributed to the increasing performance of some classifiers with average F1-Score 0.933 and 0.068 as standard deviation values.
Collapse
Affiliation(s)
- Cries Avian
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taiwan
| | - Muhammad Izzuddin Mahali
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taiwan; Department of Electronics and Informatics Engineering, Faculty of Engineering, Universitas Negeri Yogyakarta, Indonesia
| | - Nur Achmad Sulistyo Putro
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taiwan; Department of Computer Science and Electronics, Faculty of Mathematics and Natural Sciences, Universitas Gadjah Mada, Indonesia
| | - Setya Widyawan Prakosa
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taiwan
| | - Jenq-Shiou Leu
- Department of Electronic and Computer Engineering, National Taiwan University of Science and Technology, Taiwan.
| |
Collapse
|
18
|
Oh AS, Baraghoshi D, Lynch DA, Ash SY, Crapo JD, Humphries SM. Emphysema Progression at CT by Deep Learning Predicts Functional Impairment and Mortality: Results from the COPDGene Study. Radiology 2022; 304:672-679. [PMID: 35579519 PMCID: PMC9434819 DOI: 10.1148/radiol.213054] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
Background Visual assessment remains the standard for evaluating emphysema at CT; however, it is time consuming, is subjective, requires training, and is affected by variability that may limit sensitivity to longitudinal change. Purpose To evaluate the clinical and imaging significance of increasing emphysema severity as graded by a deep learning algorithm on sequential CT scans in cigarette smokers. Materials and Methods A secondary analysis of the prospective Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study participants was performed and included baseline and 5-year follow-up CT scans from 2007 to 2017. Emphysema was classified automatically according to the Fleischner emphysema grading system at baseline and 5-year follow-up using a deep learning model. Baseline and change in clinical and imaging parameters at 5-year follow-up were compared in participants whose emphysema progressed versus those who did not. Kaplan-Meier analysis and multivariable Cox regression were used to assess the relationship between emphysema score progression and mortality. Results A total of 5056 participants (mean age, 60 years ± 9 [SD]; 2566 men) were evaluated. At 5-year follow-up, 1293 of the 5056 participants (26%) had emphysema progression according to the Fleischner grading system. This group demonstrated progressive airflow obstruction (forced expiratory volume in 1 second [percent predicted]: -3.4 vs -1.8), a greater decline in 6-minute walk distance (-177 m vs -124 m), and greater progression in quantitative emphysema extent (adjusted lung density: -1.4 g/L vs 0.5 g/L; percentage of lung voxels with CT attenuation less than -950 HU: 0.6 vs 0.2) than those with nonprogressive emphysema (P < .001 for each). Multivariable Cox regression analysis showed a higher mortality rate in the group with emphysema progression, with an estimated hazard ratio of 1.5 (95% CI: 1.2, 1.8; P < .001). Conclusion An increase in Fleischner emphysema grade on sequential CT scans using an automated deep learning algorithm was associated with increased functional impairment and increased risk of mortality. ClinicalTrials.gov registration no. NCT00608764 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Grenier in this issue.
Collapse
Affiliation(s)
- Andrea S. Oh
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - David Baraghoshi
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - David A. Lynch
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - Samuel Y. Ash
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - James D. Crapo
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - Stephen M. Humphries
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| | - for the COPDGene Investigators
- From the Departments of Radiology (A.S.O., D.A.L., S.M.H.) and
Biostatistics (D.B.) and Division of Pulmonary and Critical Care Medicine,
Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St,
Denver, CO 80206; and Division of Pulmonary and Critical Care Medicine,
Department of Medicine, Brigham and Women’s Hospital, Boston, Mass
(S.Y.A.)
| |
Collapse
|
19
|
Jo YS. Long-term outcome of chronic obstructive pulmonary disease: A review. Tuberc Respir Dis (Seoul) 2022; 85:289-301. [PMID: 35822318 PMCID: PMC9537656 DOI: 10.4046/trd.2022.0074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a chronic airway inflammation characterized by fixed airflow limitation and chronic respiratory symptoms, such as cough, sputum, and dyspnea. COPD is a progressive disease characterized by a decline in lung function. During the natural course of the disease, acute deterioration of symptoms leading to hospital visits can occur and influence further disease progression and subsequent exacerbation. Moreover, COPD is not only restricted to pulmonary manifestations but can present with other systemic diseases as comorbidities or systemic manifestations, including lung cancer, cardiovascular disease, pulmonary hypertension, sarcopenia, and metabolic abnormalities. These pulmonary and extrapulmonary conditions lead to the aggravation of dyspnea, physical inactivity, decreased exercise capacity, functional decline, reduced quality of life, and increased mortality. In addition, pneumonia, which is attributed to both COPD itself and an adverse effect of treatment (especially the use of inhaled and/or systemic steroids), can occur and lead to further deterioration in the prognosis of COPD. This review summarizes the long-term outcomes of patients with COPD. In addition, recent studies on the prediction of adverse outcomes are summarized in the last part of the review.
Collapse
Affiliation(s)
- Yong Suk Jo
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
20
|
Bahramabadi R, Yousefi-Daredor H, Rezaeinejad S, Rezayati M, Arababadi MK. Down-regulation of transforming growth factor-beta and interleukin-6 serum levels in the idiopathic chronic obstructive pulmonary disease. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL IMMUNOLOGY 2022; 11:45-50. [PMID: 35874467 PMCID: PMC9301057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 06/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Idiopathic chronic obstructive pulmonary disease (ICOPD) is a prevalent human disease. The etiology of the disease is yet to be clarified. The main aim of this project was to explore serum levels of interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α) and transforming growth factor-beta (TGF-β) in the ICOPD patients in comparison to healthy controls. METHODS In this cross-sectional study, serum levels of IL-6, TNF-α and TGF-β were evaluated in the 70 non-smoker ICOPD patients and 70 sex and age matched controls, using ELISA technique by the commercial kits from Karmania Pars Gene Company. Analysis of data was performed by parametric independent and Pearson correlation test. RESULTS Serum levels of IL-6 and TGF-β, but not TNF-α, were significantly decreased in the ICOPD patients in comparison to controls. Serum levels of IL-6, TNF-α and TGF-β were not altered in the ICOPD male in comparison to female and also in mild when compared to moderate ICOPD patients. CONCLUSIONS Down-regulation of TGF-β may be the main risk factor for deterioration of inflammation in the ICOPD patients. Decreased IL-6 may be related to the idiopathic type of COPD.
Collapse
Affiliation(s)
- Reza Bahramabadi
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical SciencesRafsanjan, Iran
- Department of Immunology, Faculty of Medicine, Rafsanjan University of Medical SciencesRafsanjan, Iran
| | - Hassan Yousefi-Daredor
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical SciencesRafsanjan, Iran
- Department of Laboratory Sciences, Faculty of Paramedical, Rafsanjan University of Medical SciencesRafsanjan, Iran
| | - Sahar Rezaeinejad
- Department of Internal Medicine, Faculty of Medicine, Rafsanjan University of Medical SciencesRafsanjan, Iran
| | - Mohammadtaghi Rezayati
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical SciencesRafsanjan, Iran
- Department of Immunology, Faculty of Medicine, Rafsanjan University of Medical SciencesRafsanjan, Iran
| | - Mohammad Kazemi Arababadi
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical SciencesRafsanjan, Iran
- Department of Laboratory Sciences, Faculty of Paramedical, Rafsanjan University of Medical SciencesRafsanjan, Iran
| |
Collapse
|
21
|
Yang X, Wisselink HJ, Vliegenthart R, Heuvelmans MA, Groen HJM, Vonder M, Dorrius MD, de Bock GH. Association between Chest CT-defined Emphysema and Lung Cancer: A Systematic Review and Meta-Analysis. Radiology 2022; 304:322-330. [PMID: 35503012 DOI: 10.1148/radiol.212904] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Given the different methods of assessing emphysema, controversy exists as to whether it is associated with lung cancer. Purpose To perform a systematic review and meta-analysis of the association between chest CT-defined emphysema and the presence of lung cancer. Materials and Methods The PubMed, Embase, and Cochrane databases were searched up to July 15, 2021, to identify studies on the association between emphysema assessed visually or quantitatively with CT and lung cancer. Associations were determined by emphysema severity (trace, mild, or moderate to severe, assessed visually and quantitatively) and subtype (centrilobular and paraseptal, assessed visually). Overall and stratified pooled odds ratios (ORs) with their 95% CIs were obtained. Results Of the 3343 screened studies, 21 studies (107 082 patients) with 26 subsets were included. The overall pooled ORs for lung cancer given the presence of emphysema were 2.3 (95% CI: 2.0, 2.6; I2 = 35%; 19 subsets) and 1.02 (95% CI: 1.01, 1.02; six subsets) per 1% increase in low attenuation area. Studies with visual (pooled OR, 2.3; 95% CI: 1.9, 2.6; I2 = 48%; 12 subsets) and quantitative (pooled OR, 2.2; 95% CI: 1.8, 2.8; I2 = 3.7%; eight subsets) assessments yielded comparable results for the dichotomous assessment. Based on six studies (1716 patients), the pooled ORs for lung cancer increased with emphysema severity and were higher for visual assessment (2.5, 3.7, and 4.5 for trace, mild, and moderate to severe, respectively) than for quantitative assessment (1.9, 2.2, and 2.5) based on point estimates. Compared with no emphysema, only centrilobular emphysema (three studies) was associated with lung cancer (pooled OR, 2.2; 95% CI: 1.5, 3.2; P < .001). Conclusion Both visual and quantitative CT assessments of emphysema were associated with a higher odds of lung cancer, which also increased with emphysema severity. Regarding subtype, only centrilobular emphysema was significantly associated with lung cancer. Clinical trial registration no. CRD42021262163 © RSNA, 2022 See also the editorial by Hunsaker in this issue. Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Xiaofei Yang
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Hendrik Joost Wisselink
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Rozemarijn Vliegenthart
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Marjolein A Heuvelmans
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Harry J M Groen
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Marleen Vonder
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Monique D Dorrius
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| | - Geertruida H de Bock
- From the Departments of Epidemiology (X.Y., M.A.H., M.V., M.D.D., G.H.d.B.), Radiology (H.J.W., R.V., M.D.D.), and Pulmonary Diseases (H.J.M.G.), University Medical Center Groningen, University of Groningen, 9700 RB Groningen, the Netherlands
| |
Collapse
|
22
|
Uthoff JM, Mott SL, Larson J, Neslund-Dudas CM, Schwartz AG, Sieren JC. Computed Tomography Features of Lung Structure Have Utility for Differentiating Malignant and Benign Pulmonary Nodules. CHRONIC OBSTRUCTIVE PULMONARY DISEASES (MIAMI, FLA.) 2022; 9:154-164. [PMID: 35021316 PMCID: PMC9166332 DOI: 10.15326/jcopdf.2021.0271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a known comorbidity for lung cancer independent of smoking history. Quantitative computed tomography (qCT) imaging features related to COPD have shown promise in the assessment of lung cancer risk. We hypothesize that qCT features from the lung, lobe, and airway tree related to the location of the pulmonary nodule can be used to provide informative malignancy risk assessment. METHODS A total of 183 qCT features were extracted from 278 individuals with a solitary pulmonary nodule of known diagnosis (71 malignant, 207 benign). These included histogram and airway characteristics of the lungs, lobe, and segmental paths. Performances of the least absolute shrinkage and selection operator (LASSO) regression analysis and an ensemble of neural networks (ENN) were compared for feature set selection and classification on a testing cohort of 49 additional individuals (15 malignant, 34 benign). RESULTS The LASSO and ENN methods produced different feature sets for classification with LASSO selecting fewer qCT features (7) than the ENN (17). The LASSO model with the highest performing training area under the curve (AUC) (0.80) incorporated automatically extracted features and reader-measured nodule diameter with a testing AUC of 0.62. The ENN model with the highest performing AUC (0.77) also incorporated qCT and reader diameter but maintained higher testing performance AUC (0.79). CONCLUSIONS Automatically extracted qCT imaging features of the lung can be informative of the differentiation between individuals with malignant pulmonary nodules and those with benign pulmonary nodules, without requiring nodule segmentation and analysis.
Collapse
Affiliation(s)
- Johanna M. Uthoff
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, United States
| | - Sarah L. Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, United States
| | - Jared Larson
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
| | - Christine M. Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, United States
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, United States
| | - Ann G. Schwartz
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, United States
| | - Jessica C. Sieren
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, United States
| | - the COPDGene® Investigators
- Department of Radiology, University of Iowa, Iowa City, Iowa, United States
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa, United States
- Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, United States
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan, United States
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, United States
| |
Collapse
|
23
|
PERROTTA F, D’AGNANO V, SCIALÒ F, KOMICI K, ALLOCCA V, NUCERA F, SALVI R, STELLA GM, BIANCO A. Evolving concepts in COPD and lung cancer: a narrative review. Minerva Med 2022; 113:436-448. [DOI: 10.23736/s0026-4806.22.07962-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
24
|
[Study on the Benefit of Postoperative Exercise Rehabilitation in Patients with
Lung Cancer Complicated with Chronic Obstructive Pulmonary Disease]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:14-20. [PMID: 35078280 PMCID: PMC8796134 DOI: 10.3779/j.issn.1009-3419.2021.102.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary diseases (COPD) affects 45%-63% of lung cancer patients worldwide. Lung cancer patients complicated with COPD have decreased cardiopulmonary function and increased perioperative risk, and their postoperative exercise endurance and lung function are significantly lower than those with conventional lung cancer. Previous studies have shown that postoperative exercise training can improve the exercise endurance of unselected lung cancer patients, but it is unclear whether lung cancer patients with COPD can also benefit from postoperative exercise training. This study intends to explore the effects of postoperative exercise training on exercise endurance, daily activity and lung function of lung cancer patients with COPD. METHODS Seventy-four patients with non-small cell lung cancer (NSCLC) complicated with COPD who underwent pneumonectomy in the lung cancer center of West China Hospital of Sichuan University from August 5, 2020 to August 25, 2021 were prospectively analyzed. They were randomly divided into exercise group and control group; The patients in the two groups received routine postoperative rehabilitation in the first week after operation, and the control group was given routine nursing from the second week. On this basis, the exercise group received postoperative exercise rehabilitation training for two weeks. Baseline evaluation was performed 3 days before operation and endpoint evaluation was performed 3 weeks after operation. RESULTS The exercise endurance, daily activity and pulmonary function test results of the two groups decreased from baseline to the end point. However, after the operation and intervention program, the maximum oxygen consumption of Cardiopulmonary Exercise Test and the walking distance of 6-Minute Walking Test in the exercise group were significantly better than those in the control group [(13.09±1.46) mL/kg/min vs (11.89±1.38) mL/kg/min, P=0.033; (297±46) m vs (243±43) m, P=0.041]. The average number of we-chat steps in the exercise group was also significantly better than that in the control group (4,381±397 vs 3,478±342, P=0.035). Forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) in the exercise group were better than those in the control group, but the difference did not reach a statistically significant level [(1.76±0.19) L vs (1.60±0.28) L, P=0.084; (1.01±0.17) L vs (0.96±0.21) L, P=0.467]. CONCLUSIONS Postoperative exercise rehabilitation training can improve exercise endurance and daily activity ability of patients with lung cancer complicated with COPD and promote postoperative rehabilitation.
Collapse
|
25
|
Le TT, Qato DM, Magder L, Bjarnadóttir M, Zafari Z, Simoni-Wastila L. Prevalence and Newly Diagnosed Rates of Multimorbidity in Older Medicare Beneficiaries with COPD. COPD 2021; 18:541-548. [PMID: 34468243 DOI: 10.1080/15412555.2021.1968815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Few studies have quantified the multimorbidity burden in older adults with chronic obstructive pulmonary disease (COPD) using large and generalizable data. Such evidence is essential to inform evidence-based research, clinical care, and resource allocation. This retrospective cohort study used a nationally representative sample of Medicare beneficiaries aged 65 years or older with COPD and 1:1 matched (on age, sex, and race) non-COPD beneficiaries to: (1) quantify the prevalence of multimorbidity at COPD onset and one-year later; (2) quantify the rates [per 100 person-years (PY)] of newly diagnosed multimorbidity during in the year prior to and in the year following COPD onset; and (3) compare multimorbidity prevalence in beneficiaries with and without COPD. Among 739,118 eligible beneficiaries with and without COPD, the average number of multimorbidity was 10.0 (SD = 4.7) and 1.0 (SD = 3.3), respectively. The most prevalent multimorbidity at COPD onset and at one-year after, respectively, were hypertension (70.8% and 80.2%), hyperlipidemia (52.2% and 64.8%), anemia (42.1% and 52.0%), arthritis (39.8% and 47.7%), and congestive heart failure (CHF) (31.3% and 38.8%). Conditions with the highest newly diagnosed rates before and following COPD onset, respectively, included hypertension (39.8 and 32.3 per 100 PY), hyperlipidemia (22.8 and 27.6), anemia (17.8 and 20.3), CHF (16.2 and 13.2), and arthritis (12.9 and 13.2). COPD was significantly associated with increased odds of all measured conditions relative to non-COPD controls. This study updates existing literature with more current, generalizable findings of the substantial multimorbidity burden in medically complex older adults with COPD-necessary to inform patient-centered, multidimensional care.Supplemental data for this article is available online at https://doi.org/10.1080/15412555.2021.1968815 .
Collapse
Affiliation(s)
- Tham T Le
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| | - Danya M Qato
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Larry Magder
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Margrét Bjarnadóttir
- Department of Decision, Operation, and Information Technologies, University of Maryland, College Park, MD, USA
| | - Zafar Zafari
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
| | - Linda Simoni-Wastila
- Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA.,Peter Lamy Center for Drug Therapeutic and Aging, University of Maryland, College Park, MD, USA
| |
Collapse
|
26
|
Li P, Wang Y, Wang X, Liu L, Chen L. Identification of Susceptible Genes for Chronic Obstructive Pulmonary Disease with Lung Adenocarcinoma by Weighted Gene Co-Expression Network Analysis. Onco Targets Ther 2021; 14:3625-3634. [PMID: 34113128 PMCID: PMC8187107 DOI: 10.2147/ott.s303544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/13/2021] [Indexed: 02/05/2023] Open
Abstract
Purpose Chronic obstructive pulmonary disease (COPD) and lung adenocarcinoma (LUAD) are common disorders and usually co-exists. However, genetic mechanisms between COPD and LUAD are rarely reported. This study aims to identify susceptible genes of COPD with LUAD. Methods Using the published data of GSE106899, co-expression modules were constructed by weighted gene co-expression network analysis (WGCNA). Subsequently, top 50 genes in the most tumor-related module were identified, among which hub genes were selected and validated. Results Twenty co-expression modules were constructed on 13,865 genes from 62 lung tissues of COPD patients with or without LUAD, in which one module (blue) was most related to tumorigenesis. Functional enrichment analyses showed that the genes in the blue module were mainly enriched in cell cycle, DNA transcription/replication and cancer pathways, etc. Combined with protein–protein interaction network, MTA1, PKMYT1 and FZR1 genes had the most intramodular connectivity, which were regarded as the hub genes. However, only FZR1 was validated to be overexpressed in lung tissues of COPD with LUAD and cigarette smoke extract-stimulated A549 cells, a human LUAD cell line. Conclusion This study suggests overexpression of FZR1 may play a key role in the tumorigenesis of LUAD in patients with COPD.
Collapse
Affiliation(s)
- Ping Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Youyu Wang
- Department of Thoracic Surgery, Sichuan Provincial People's Hospital, Sichuan Academy of Medical Sicences, Chengdu, Sichuan, 610072, People's Republic of China
| | - Xiaoli Wang
- Department of Gynecology and Obstetrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lin Liu
- Department of Respiratory and Critical Care Medicine, 363 Hospital, Chengdu, Sichuan, 610041, People's Republic of China
| | - Lei Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, 610041, People's Republic of China
| |
Collapse
|
27
|
Aloe C, Wang H, Vlahos R, Irving L, Steinfort D, Bozinovski S. Emerging and multifaceted role of neutrophils in lung cancer. Transl Lung Cancer Res 2021; 10:2806-2818. [PMID: 34295679 PMCID: PMC8264329 DOI: 10.21037/tlcr-20-760] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 01/13/2021] [Indexed: 12/20/2022]
Abstract
It has long been recognized that cigarette smoking is a shared risk factor for lung cancer and the debilitating lung disease, chronic obstructive pulmonary disease (COPD). As the severity of COPD increases, so does the risk for developing lung cancer, independently of pack years smoked. Neutrophilic inflammation increases with COPD severity and anti-inflammatories such as non-steroidal anti-inflammatory drugs (NSAIDs) can modulate neutrophil function and cancer risk. This review discusses the biology of tumour associated neutrophils (TANs) in lung cancer, which increase in density with tumour progression, particularly in smokers with non-small cell lung cancer (NSCLC). It is now increasingly recognized that neutrophils are responsive to the tumour microenvironment (TME) and polarize into distinct phenotypes that operate in an anti- (N1) or pro-tumorigenic (N2) manner. Intriguingly, the emergence of the pro-tumorigenic N2 phenotype increases with tumour growth, to suggest that cancer cells and the surrounding stroma can re-educate neutrophils. The neutrophil itself is a potent source of reactive oxygen species (ROS), arginase, proteases and cytokines that paradoxically can exert a potent immunosuppressive effect on lymphocytes including cytotoxic T cells (CTLs). Indeed, the neutrophil to lymphocyte ratio (NLR) is a systemic biomarker that is elevated in lung cancer patients and prognostic for poor survival outcomes. Herein, we review the molecular mechanisms by which neutrophil derived mediators can suppress CTL function. Selective therapeutic strategies designed to suppress pathogenic neutrophils in NSCLC may cooperate with immune checkpoint inhibitors (ICI) to increase CTL killing of cancer cells in the TME.
Collapse
Affiliation(s)
- Christian Aloe
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Hao Wang
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Ross Vlahos
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Steven Bozinovski
- School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia
| |
Collapse
|
28
|
Kim Y, Kim YJ, Kang YM, Cho WK. Exploring the impact of number and type of comorbidities on the risk of severe COPD exacerbations in Korean Population: a Nationwide Cohort Study. BMC Pulm Med 2021; 21:151. [PMID: 33957924 PMCID: PMC8101227 DOI: 10.1186/s12890-021-01497-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background It is difficult to assess the impact of multiple comorbidities on clinical outcomes in chronic obstructive pulmonary disease (COPD). In this study, we aimed to investigate exacerbation-associated comorbidities, determine whether the number of comorbidities is an independent risk factor for exacerbation, and identify other exacerbation-associated factors in a Korean COPD population using a nationwide population-based cohort. This study focused on severe exacerbations that required hospitalisation or emergency room visits. Methods The National Health Insurance Service-National Sample Cohort, version 2.0, data sampled between 2002 and 2015 were analysed. Data from two years after the diagnosis of COPD were analysed for each participant (N = 12,554, entire cohort). Moreover, 42% of the participants underwent additional health examinations (N = 5306, health-screening cohort). Fifteen comorbidities that were previously reported as risk factors for exacerbations were examined. A logistic regression model was used to analyse association with exacerbations. Results Asthma (1.57 [1.39–1.76] and 1.24 [1.06–1.44]), lung cancer (1.84 [1.30–2.59] and 2.28 [1.54–3.37]), and heart failure (1.39 [1.16–1.67] and 1.52 [1.18–1.97]) were associated with exacerbation in both cohorts (odds ratio [95% confidence interval] in the entire cohort and health-screening cohort, respectively). The number of comorbidities was an independent risk factor, and old age, male sex, low body mass index, and current smoking were also independent risk factors. High cholesterol levels and body mass index exerted protective effects against exacerbation. Conclusions The number of comorbidities, certain comorbidities such as asthma, lung cancer and heart failure, and low BMI were associated with an increased risk of severe exacerbation in COPD patients.
Collapse
Affiliation(s)
- Youngmee Kim
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Yu Mi Kang
- Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, USA
| | - Won-Kyung Cho
- International Healthcare Center, Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| |
Collapse
|
29
|
Snoeckx A, Franck C, Silva M, Prokop M, Schaefer-Prokop C, Revel MP. The radiologist's role in lung cancer screening. Transl Lung Cancer Res 2021; 10:2356-2367. [PMID: 34164283 PMCID: PMC8182709 DOI: 10.21037/tlcr-20-924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Lung cancer is still the deadliest cancer in men and women worldwide. This high mortality is related to diagnosis in advanced stages, when curative treatment is no longer an option. Large randomized controlled trials have shown that lung cancer screening (LCS) with low-dose computed tomography (CT) can detect lung cancers at earlier stages and reduce lung cancer-specific mortality. The recent publication of the significant reduction of cancer-related mortality by 26% in the Dutch-Belgian NELSON LCS trial has increased the likelihood that implementation of LCS in Europe will move forward. Radiologists are important stakeholders in numerous aspects of the LCS pathway. Their role goes beyond nodule detection and nodule management. Being part of a multidisciplinary team, radiologists are key players in numerous aspects of implementation of a high quality LCS program. In this non-systematic review we discuss the multifaceted role of radiologists in LCS.
Collapse
Affiliation(s)
- Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Caro Franck
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Parma, Italy
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Marie-Pierre Revel
- Department of Radiology, Cochin Hospital, APHP Centre, Université de Paris, Paris, France
| |
Collapse
|
30
|
Rodrigues SD, Ueda RM, Barreto AC, Zanini RR, Souza AM. How atmospheric pollutants impact the development of chronic obstructive pulmonary disease and lung cancer: A var-based model. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 275:116622. [PMID: 33578319 DOI: 10.1016/j.envpol.2021.116622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/13/2021] [Accepted: 01/28/2021] [Indexed: 06/12/2023]
Abstract
The impact of air pollution on humans is a worrisome factor that has gained prominence over the years due to the importance of the topic to society. Lung cancer and chronic obstructive pulmonary disease are among the diseases associated with pollution that increase the mortality rate in Brazil and worldwide. Therefore, this study aimed to determine the impacts of air pollutants on mortality rates from chronic obstructive pulmonary disease (COPD) and lung cancer (LC) using vector autoregressive (VAR) modeling. The adjusted model was a VAR(1) and, according to the Granger causality test, the air pollutants selected were PM10, O3, CO, NO2, and SO2. The shocks applied to the variables O3, using the impulse response function, negatively impacted COPD; in the eighth period, which is stabilized. The LC variable suffered more significant variations from O3 and after a shock in this variable, an initially negative response in LC occurred and the series stabilized in period nine. After one year, 20.19% of COPD variance was explained by O3. After twelve months, the atmospheric pollutant O3 represented 5.00% and NO2 represented 4.02% of LC variance. Moreover, the variables that caused the highest impact on COPD and LC mortality rates were O3 and NO2, indicating that air pollution influences the clinical state of people who have these diseases and even contributes to their development. The VAR model was able to identify the air pollutants that have the most significant impact on the diseases analyzed and explained the interrelationship between them.
Collapse
Affiliation(s)
- Stéfane Dias Rodrigues
- Federal University of Santa Maria -UFSM, Department of Statistics and Modeling, Av. Roraima, 1000, Bairro Camobi, Santa Maria, RS, 97.105-900, Brazil.
| | - Renan Mitsuo Ueda
- Federal University of Santa Maria -UFSM, Department of Statistics and Modeling, Av. Roraima, 1000, Bairro Camobi, Santa Maria, RS, 97.105-900, Brazil
| | - Alisson Castro Barreto
- Federal University of Santa Maria -UFSM, Department of Statistics and Modeling, Av. Roraima, 1000, Bairro Camobi, Santa Maria, RS, 97.105-900, Brazil
| | - Roselaine Ruviaro Zanini
- Federal University of Santa Maria -UFSM, Department of Statistics and Modeling, Av. Roraima, 1000, Bairro Camobi, Santa Maria, RS, 97.105-900, Brazil
| | - Adriano Mendonça Souza
- Federal University of Santa Maria -UFSM, Department of Statistics and Modeling, Av. Roraima, 1000, Bairro Camobi, Santa Maria, RS, 97.105-900, Brazil
| |
Collapse
|
31
|
Shih YM, Chang YJ, Cooke MS, Pan CH, Hu CH, Chao MR, Hu CW. Alkylating and oxidative stresses in smoking and non-smoking patients with COPD: Implications for lung carcinogenesis. Free Radic Biol Med 2021; 164:99-106. [PMID: 33418114 PMCID: PMC7897309 DOI: 10.1016/j.freeradbiomed.2020.12.442] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/24/2020] [Accepted: 12/25/2020] [Indexed: 02/07/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a disease characterized by chronic inflammation and irreversible airway obstruction. Cigarette smoking is the predominant risk factor for developing COPD. It is well-known that the COPD is also strongly associated with an increased risk of developing lung cancer. Cigarette smoke contains elevated concentrations of oxidants and various carcinogens (e.g., tobacco-derived nitrosamines) that can cause oxidative and alkylating stresses, which can also arise from inflammation. However, it is surprising that, except for oxidative stress, little information is available on the burden of alkylating stress and the detoxification efficiency of tobacco-derived carcinogens in COPD patients. In this study, we used LC-MS/MS to measure the archetypical tobacco-specific carcinogenic 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK), its major metabolite, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL), three biomarkers of oxidative stress (8-oxo-7,8-dihydroguanine, 8-oxoGua; 8-oxo-7,8-dihydro-2'-deoxyguanosine, 8-oxodGuo; 8-oxo-7,8-dihydroguanosine, 8-oxoGuo) and two biomarkers of alkylating stress (N7-methylguanine, N7-MeGua and N3-methyladenine, N3-MeAde), in the urine of smoking and non-smoking COPD patients and healthy controls. Our results showed that not only was oxidative stress significantly elevated in the COPD patients compared to the controls, but also alkylating stress. Significantly, levels of alkylating stress (i.e., N7-MeGua) were highly correlated with the COPD severity and not affected by age and smoking status. Furthermore, COPD smokers had significantly higher ratios of free NNAL to the total NNAL than control smokers, implying a lower detoxification efficiency of NNK in COPD smokers. This ratio was even higher in COPD smokers with stages 3-4 than in COPD smokers with stages 1-2. Taken together, our results demonstrated that the detoxification efficiency of tobacco-derived carcinogens (e.g., NNK) was associated with the pathogenesis and possibly the progression of COPD. In addition to oxidative stress, alkylating stress derived from chronic inflammation appears to be also dominant in COPD patients.
Collapse
Affiliation(s)
- Ying-Ming Shih
- Department of Public Health, Chung Shan Medical University, Taichung, 402, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, 500, Taiwan
| | - Yuan-Jhe Chang
- Department of Occupational Safety and Health, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Marcus S Cooke
- Oxidative Stress Group, Department of Cell Biology, Microbiology and Molecular Biology, University of South Florida, Tampa, FL, 33620, USA
| | - Chih-Hong Pan
- Institute of Labor, Occupational Safety and Health, Ministry of Labor, New Taipei City, 221, Taiwan
| | - Ching-Hsuan Hu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, 333, Taiwan
| | - Mu-Rong Chao
- Department of Occupational Safety and Health, Chung Shan Medical University, Taichung, 402, Taiwan.
| | - Chiung-Wen Hu
- Department of Public Health, Chung Shan Medical University, Taichung, 402, Taiwan; Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan.
| |
Collapse
|
32
|
Gariazzo C, Binazzi A, Alfò M, Massari S, Stafoggia M, Marinaccio A. Predictors of Lung Cancer Risk: An Ecological Study Using Mortality and Environmental Data by Municipalities in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1896. [PMID: 33669318 PMCID: PMC7922734 DOI: 10.3390/ijerph18041896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 01/04/2023]
Abstract
Lung cancer (LC) mortality remains a consistent part of the total deaths occurring worldwide. Its etiology is complex as it involves multifactorial components. This work aims in providing an epidemiological assessment on occupational and environmental factors associated to LC risk by means of an ecological study involving the 8092 Italian municipalities for the period 2006-2015. We consider mortality data from mesothelioma as proxy of asbestos exposure, as well as PM2.5 and radon levels as a proxy of environmental origin. The compensated cases for occupational respiratory diseases, urbanization and deprivation were included as predictors. We used a negative binomial distribution for the response, with analysis stratified by gender. We estimated that asbestos is responsible for about 1.1% (95% CI: 0.8, 1.4) and 0.5% (95% CI: 0.2, 0.8) of LC mortality in males and females, respectively. The corresponding figures are 14.0% (95% CI: 12.5, 15.7) and 16.3% (95% CI: 16.2, 16.3) for PM2.5 exposure, and 3.9% (95% CI: 3.5, 4.2) and 1.6% (95% CI: 1.4, 1.7) for radon exposure. The assessment of determinants contribution to observed LC deaths is crucial for improving awareness of its origin, leading to increase the equity of the welfare system.
Collapse
Affiliation(s)
- Claudio Gariazzo
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| | - Alessandra Binazzi
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| | - Marco Alfò
- Department of Statistic, University of Roma “Sapienza”, 00185 Rome, Italy;
| | - Stefania Massari
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, 00154 Rome, Italy;
| | - Alessandro Marinaccio
- Occupational and Environmental Medicine Epidemiology and Hygiene Department, Italian Workers’ Compensation Authority (INAIL), 00144 Rome, Italy; (A.B.); (S.M.); (A.M.)
| |
Collapse
|
33
|
Quantification of Perinodular Emphysema in High-risk Patients Offers No Benefit in Lung Nodule Risk-Stratification of Malignancy Potential. J Thorac Imaging 2020; 35:108-114. [PMID: 31876554 DOI: 10.1097/rti.0000000000000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE Pulmonary nodules, found either incidentally or on lung cancer screening, are common. Evaluating the benign or malignant nature of these nodules is costly in terms of patient risk and expense. The presence of both global and regional emphysema has been linked to increased lung cancer risk. We sought to determine whether the measurement of emphysema directly adjacent to a lung nodule could inform the likelihood of a nodule being malignant. MATERIALS AND METHODS Within a population of Veterans at high risk for lung cancer, 58 subjects with malignant nodules found on computerized tomographic chest scans were matched by lobe and nodule size to 58 controls. Lung densitometry was measured via determination of the low attenuation area percentage at -950 Hounsfield units (LAA950) and the Hounsfield unit (HU) value at which 15% of lung voxels have a lower lung density (Perc15), at predefined lung volumes that encompassed the nodule to evaluate both perinodular and regional lung fields. The association between measured lung density and malignancy was investigated using conditional logistic regression models, with densitometry measurements used as the primary predictor, adjusting for age alone, or age and computerized tomographic scan characteristics. RESULTS No significant differences in emphysema measurements between malignant and benign nodules were identified at lung volumes encompassing both perinodular and regional emphysema. Furthermore, emphysema quantification remained stable across lung volumes within individuals. CONCLUSIONS In this study, quantifying the degree of perinodular or regional emphysema did not offer any benefit in the risk stratification of lung nodules.
Collapse
|
34
|
Quantitative Emphysema on Low-Dose CT Imaging of the Chest and Risk of Lung Cancer and Airflow Obstruction: An Analysis of the National Lung Screening Trial. Chest 2020; 159:1812-1820. [PMID: 33326807 DOI: 10.1016/j.chest.2020.12.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Lung cancer risk prediction models do not routinely incorporate imaging metrics available on low-dose CT (LDCT) imaging of the chest ordered for lung cancer screening. RESEARCH QUESTION What is the association between quantitative emphysema measured on LDCT imaging and lung cancer incidence and mortality, all-cause mortality, and airflow obstruction in individuals who currently or formerly smoked and are undergoing lung cancer screening? STUDY DESIGN AND METHODS In 7,262 participants in the CT arm of the National Lung Screening Trial, percent low attenuation area (%LAA) was defined as the percentage of lung volume with voxels less than -950 Hounsfield units on the baseline examination. Multivariable Cox proportional hazards models, adjusting for competing risks where appropriate, were built to test for association between %LAA and lung cancer incidence, lung cancer mortality, and all-cause mortality with censoring at 6 years. In addition, multivariable logistic regression models were built to test the cross-sectional association between %LAA and airflow obstruction on spirometry, which was available in 2,700 participants. RESULTS The median %LAA was 0.8% (interquartile range, 0.2%-2.7%). Every 1% increase in %LAA was independently associated with higher hazards of lung cancer incidence (hazard ratio [HR], 1.02; 95% CI, 1.01-1.03; P = .004), lung cancer mortality (HR, 1.02; 95% CI, 1.00-1.05; P = .045), and all-cause mortality (HR, 1.01; 95% CI, 1.00-1.03; P = .042). Among participants with spirometry, 892 had airflow obstruction. The likelihood of airflow obstruction increased with every 1% increase in %LAA (odds ratio, 1.07; 95% CI, 1.06-1.09; P < .001). A %LAA cutoff of 1% had the best discriminative accuracy for airflow obstruction in participants aged > 65 years. INTERPRETATION Quantitative emphysema measured on LDCT imaging of the chest can be leveraged to improve lung cancer risk prediction and help diagnose COPD in individuals who currently or formerly smoked and are undergoing lung cancer screening.
Collapse
|
35
|
Yoneyama R, Saji H, Takeuchi S, Ikeda N. Lung cancer and obstructive lung disease in never smokers. J Thorac Dis 2020; 12:3934-3939. [PMID: 32944303 PMCID: PMC7475531 DOI: 10.21037/jtd.2020.04.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Remi Yoneyama
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hisashi Saji
- Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Susumu Takeuchi
- Department of Surgery, Tokyo Medical University, Tokyo, Japan.,Department of Pulmonary Medicine and Oncology, Nippon Medical School, Tokyo, Japan
| | - Norihiko Ikeda
- Department of Surgery, Tokyo Medical University, Tokyo, Japan
| |
Collapse
|
36
|
Heo JW, Kang HS, Park CK, Kim SK, Kim JS, Kim JW, Kim SJ, Lee SH, Yeo CD. Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients. BMC Pulm Med 2020; 20:242. [PMID: 32917179 PMCID: PMC7488536 DOI: 10.1186/s12890-020-01268-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 08/19/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Lung cancer is a frequent comorbidity of chronic obstructive pulmonary disease (COPD). However, the local risk of developing lung cancer related to regional emphysema distribution and clinical outcome has not been investigated. Our aim was to evaluate the impact of regional emphysema score (RES) on tumor location and prognosis in non-small cell lung cancer (NSCLC) patients. METHODS We enrolled 457 patients who underwent curative surgery for NSCLC at seven hospitals at The Catholic University of Korea from 2014 to 2018. Emphysema was visually assessed for each lobe, with the lingula as a separate lobe. Semi-quantitative emphysema scoring was classified as follows: 0 = none, 0.5 = 1 to 10%, 1 = 11 to 25%, 2 = 26 to 50%, 3 = 51 to 75%, and 4 = 76 to 100%. An RES was given to each of the six lung zone: the upper, middle, and lower lobes in the right and left lungs. RESULTS There were 145 patients in the high RES (≥ 3) group and 312 in the low RES (< 3) group. The mean RES in each lobe with cancer was significantly higher than that in other lobes without cancer (0.51 vs. 0.37, P < 0.001). This group showed significantly shorter disease-free survival (P < 0.001), in addition, presence of COPD, low diffusing capacity of the lung for carbon monoxide (< 80), smoking status, and poor differentiation were more frequent in this group. Also, cancer in a lobe with a higher RES (odds ratio (OR) = 1.56; 95% confidence interval (CI:1.01-2.42; P = 0.04), pathologic stage ≥ III (OR = 2.23; 95% CI: 1.28-3.89; P < 0.001), and poor differentiation (OR = 1.99; 95% CI: 1.22-3.21; P < 0.001) were independent factors for tumor recurrence. CONCLUSIONS The regional severity of emphysema by visual qualification was associated with the location of lung cancer, and was an independently poor prognostic factor for tumor recurrence in completely resected NSCLC patients.
Collapse
Affiliation(s)
- Jung Won Heo
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Hye Seon Kang
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chan Kwon Park
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Kyoung Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ju Sang Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Woo Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Joon Kim
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea
| | - Chang Dong Yeo
- Division of Pulmonary, Critical Care and Allergy, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul, 03312, Republic of Korea.
| |
Collapse
|
37
|
Gagnat AA, Gjerdevik M, Lie SA, Gulsvik A, Bakke P, Nielsen R. Acute exacerbations of COPD and risk of lung cancer in COPD patients with and without a history of asthma. Eur Clin Respir J 2020; 7:1799540. [PMID: 32944202 PMCID: PMC7480432 DOI: 10.1080/20018525.2020.1799540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rationale There is limited knowledge on the effect of acute exacerbations in chronic obstructive pulmonary disease (AECOPD) on lung cancer risk in COPD patients with and without a history of asthma. This study aims to examine whether AECOPD is associated with risk of lung cancer, and whether the effect depends on a history of asthma. Methods In the GenKOLS study of 2003–2005, 852 subjects with COPD performed spirometry, and filled out questionnaires on smoking habits, symptoms and disease history. These data were linked to lung cancer data from the Cancer Registry of Norway through 2013. AECOPD, measured at baseline was the main predictor. To quantify differences in lung cancer risk, we performed Cox-proportional hazards regression. We adjusted for sex, age, smoking variables, body mass index, and lung function. Measurements and results During follow-up, 8.8% of the subjects with, and 5.9% of the subjects without exacerbations were diagnosed with lung cancer. Cox regression showed a significant increased risk of lung cancer with one or more exacerbations in COPD patients without a history of asthma, HRR = 2.77 (95% CI 1.39–5.52). We found a significant interaction between a history of asthma and AECOPD on lung cancer. Conclusions AECOPD is associated with an increased risk of lung cancer in COPD patients without a history of asthma.
Collapse
Affiliation(s)
- Ane Aamli Gagnat
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Miriam Gjerdevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stein Atle Lie
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Amund Gulsvik
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Per Bakke
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Rune Nielsen
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
38
|
Ruparel M, Quaife SL, Dickson JL, Horst C, Tisi S, Hall H, Taylor MN, Ahmed A, Shaw PJ, Burke S, Soo MJ, Nair A, Devaraj A, Sennett K, Hurst JR, Duffy SW, Navani N, Bhowmik A, Baldwin DR, Janes SM. Prevalence, Symptom Burden, and Underdiagnosis of Chronic Obstructive Pulmonary Disease in a Lung Cancer Screening Cohort. Ann Am Thorac Soc 2020; 17:869-878. [PMID: 32164439 PMCID: PMC7328177 DOI: 10.1513/annalsats.201911-857oc] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/02/2020] [Indexed: 12/19/2022] Open
Abstract
Rationale: Individuals eligible for lung cancer screening (LCS) by low-dose computed tomography (LDCT) are also at risk of chronic obstructive pulmonary disease (COPD) due to age and smoking exposure. Whether the LCS episode is useful for early detection of COPD is not well established.Objectives: To explore associations between symptoms, comorbidities, spirometry, and emphysema in participants enrolled in the Lung Screen Uptake Trial.Methods: This cross-sectional study was a prespecified analysis nested within Lung Screen Uptake Trial, which was a randomized study testing the impact of differing invitation materials on attendance of 60- to 75-year-old smokers and ex-smokers to a "lung health check" between November 2015 and July 2017. Participants with a smoking history ≥30 pack-years and who quit ≤15 years ago, or meeting a lung cancer risk of ≥1.51% via the Prostate Lung Colorectal Ovarian model or ≥2.5% via the Liverpool Lung Project model, were offered LDCT. COPD was defined and classified according to the GOLD (Global Initiative for Obstructive Lung Disease) criteria using prebronchodilator spirometry. Analyses included the use of descriptive statistics, chi-square tests to examine group differences, and univariable and multivariable logistic regression to explore associations between symptom prevalence, airflow limitation, and visually graded emphysema.Results: A total of 560 of 986 individuals included in the analysis (57%) had prebronchodilator spirometry consistent with COPD; 67% did not have a prior history of COPD and were termed "undiagnosed." Emphysema prevalence in those with known and "undiagnosed" COPD was 73% and 68%, respectively. A total of 32% of those with "undiagnosed COPD" had no emphysema on LDCT. Inhaler use and symptoms were more common in the "known" than the "undiagnosed" COPD group (63% vs. 33% with persistent cough [P < 0.001]; 73% vs. 33% with dyspnea [P < 0.001]). Comorbidities were common in all groups. Adjusted odds ratio (aOR) of respiratory symptoms were more significant for airflow obstruction (aOR GOLD 1 and 2, 1.57; confidence interval [CI], 1.14-2.17; aOR GOLD 3 and 4, 4.6; CI, 2.17-9.77) than emphysema (aOR mild, 1.12; CI, 0.81-1.55; aOR moderate, 1.33; CI, 0.85-2.09; aOR severe, 4.00; CI, 1.57-10.2).Conclusions: There is high burden of "undiagnosed COPD" and emphysema in LCS participants. Adding spirometry findings to the LDCT enhances identification of individuals with COPD.Clinical trial registered with www.clinicaltrials.gov (NCT02558101).
Collapse
Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, University College London (UCL) Respiratory
| | | | - Jennifer L. Dickson
- Lungs for Living Research Centre, University College London (UCL) Respiratory
| | - Carolyn Horst
- Lungs for Living Research Centre, University College London (UCL) Respiratory
| | - Sophie Tisi
- Lungs for Living Research Centre, University College London (UCL) Respiratory
| | - Helen Hall
- Lungs for Living Research Centre, University College London (UCL) Respiratory
| | | | | | | | | | | | | | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London, United Kingdom
| | - Karen Sennett
- Killick Street Health Centre, London, United Kingdom
| | - John R. Hurst
- UCL Centre for Inflammation and Repair, University College London, London, United Kingdom
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom; and
| | - Neal Navani
- Lungs for Living Research Centre, University College London (UCL) Respiratory
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom
| | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Sam M. Janes
- Lungs for Living Research Centre, University College London (UCL) Respiratory
| |
Collapse
|
39
|
Veronesi G, Baldwin DR, Henschke CI, Ghislandi S, Iavicoli S, Oudkerk M, De Koning HJ, Shemesh J, Field JK, Zulueta JJ, Horgan D, Fiestas Navarrete L, Infante MV, Novellis P, Murray RL, Peled N, Rampinelli C, Rocco G, Rzyman W, Scagliotti GV, Tammemagi MC, Bertolaccini L, Triphuridet N, Yip R, Rossi A, Senan S, Ferrante G, Brain K, van der Aalst C, Bonomo L, Consonni D, Van Meerbeeck JP, Maisonneuve P, Novello S, Devaraj A, Saghir Z, Pelosi G. Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:E1672. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12061672] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
Collapse
Affiliation(s)
- Giulia Veronesi
- Faculty of Medicine and Surgery—Vita-Salute San Raffaele University, 20132 Milan, Italy;
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - David R. Baldwin
- Department of Respiratory Medicine, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Claudia I. Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Simone Ghislandi
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | - Sergio Iavicoli
- Department of Occupational and Environmental Medicine, Epidemiology and Hygiene, Italian Workers’ Compensation Authority (INAIL), 00078 Rome, Italy;
| | - Matthijs Oudkerk
- Center for Medical Imaging, University Medical Center Groningen, University of Groningen, 9712 CP Groningen, The Netherlands;
| | - Harry J. De Koning
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Joseph Shemesh
- The Grace Ballas Cardiac Research Unit, Sheba Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, 52621 Tel Aviv-Yafo, Israel;
| | - John K. Field
- Roy Castle Lung Cancer Research Programme, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool, Liverpool L69 3BX, UK;
| | - Javier J. Zulueta
- Department of Pulmonology, Clinica Universidad de Navarra, 31008 Pamplona, Spain;
- Visiongate Inc., Phoenix, AZ 85044, USA
| | - Denis Horgan
- European Alliance for Personalised Medicine (EAPM), Avenue de l’Armée Legerlaan 10, 1040 Brussels, Belgium;
| | - Lucia Fiestas Navarrete
- Department of Social and Political Sciences, Bocconi University, 20136 Milan, Italy; (S.G.); (L.F.N.)
| | | | - Pierluigi Novellis
- Division of Thoracic Surgery, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Rachael L. Murray
- Division of Epidemiology and Public Health, UK Centre for Tobacco and Alcohol Studies, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham NG5 1PB, UK;
| | - Nir Peled
- The Legacy Heritage Oncology Center & Dr. Larry Norton Institute, Soroka Medical Center & Ben-Gurion University, 84101 Beer-Sheva, Israel;
| | - Cristiano Rampinelli
- Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Gaetano Rocco
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, 80-210 Gdańsk, Poland;
| | | | - Martin C. Tammemagi
- Department of Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St Catharines, ON L2S 3A1, Canada;
| | - Luca Bertolaccini
- Division of Thoracic Surgery, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Natthaya Triphuridet
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
- Faculty of Medicine and Public Health, Chulabhorn Royal Academy, HRH Princess Chulabhorn College of Medical Science, Bangkok 10210, Thailand
| | - Rowena Yip
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; (C.I.H.); (N.T.); (R.Y.)
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy;
| | - Suresh Senan
- Department of Radiation Oncology, Amsterdam University Medical Centers, VU location, De Boelelaan 1117, Postbox 7057, 1007 MB Amsterdam, The Netherlands;
| | - Giuseppe Ferrante
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center IRCCS, 20089 Rozzano (MI), Italy;
| | - Kate Brain
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff CF14 4YS, UK;
| | - Carlijn van der Aalst
- Department of Public Health, Erasmus MC—University Medical Centre Rotterdam, 3015 GD Rotterdam, The Netherlands; (H.J.D.K.); (C.v.d.A.)
| | - Lorenzo Bonomo
- Department of Bioimaging and Radiological Sciences, Catholic University, 00168 Rome, Italy;
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Jan P. Van Meerbeeck
- Thoracic Oncology, Antwerp University Hospital and Ghent University, 2650 Edegem, Belgium;
| | - Patrick Maisonneuve
- Division of Epidemiology and Biostatistics, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy;
| | - Silvia Novello
- Department of Oncology, University of Torino, 10124 Torino, Italy; (G.V.S.); (S.N.)
| | - Anand Devaraj
- Department of Radiology, Royal Brompton Hospital, London SW3 6NP, UK;
| | - Zaigham Saghir
- Department of Respiratory Medicine, Herlev-Gentofte University Hospital, 2900 Hellerup, Denmark;
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Inter-Hospital Pathology Division, IRCCS MultiMedica, 20138 Milan, Italy
| |
Collapse
|
40
|
Recommendations for Implementing Lung Cancer Screening with Low-Dose Computed Tomography in Europe. Cancers (Basel) 2020; 12:0. [PMID: 32599792 PMCID: PMC7352874 DOI: 10.3390/cancers12060000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lung cancer screening (LCS) with low-dose computed tomography (LDCT) was demonstrated in the National Lung Screening Trial (NLST) to reduce mortality from the disease. European mortality data has recently become available from the Nelson randomised controlled trial, which confirmed lung cancer mortality reductions by 26% in men and 39-61% in women. Recent studies in Europe and the USA also showed positive results in screening workers exposed to asbestos. All European experts attending the "Initiative for European Lung Screening (IELS)"-a large international group of physicians and other experts concerned with lung cancer-agreed that LDCT-LCS should be implemented in Europe. However, the economic impact of LDCT-LCS and guidelines for its effective and safe implementation still need to be formulated. To this purpose, the IELS was asked to prepare recommendations to implement LCS and examine outstanding issues. A subgroup carried out a comprehensive literature review on LDCT-LCS and presented findings at a meeting held in Milan in November 2018. The present recommendations reflect that consensus was reached.
Collapse
|
41
|
García-Fernández C, Fornaguera C, Borrós S. Nanomedicine in Non-Small Cell Lung Cancer: From Conventional Treatments to Immunotherapy. Cancers (Basel) 2020; 12:E1609. [PMID: 32570729 PMCID: PMC7352459 DOI: 10.3390/cancers12061609] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/15/2020] [Accepted: 06/15/2020] [Indexed: 02/06/2023] Open
Abstract
Non-small cell lung cancer (NSCLC) remains the most common cause of cancer-related mortality. The heterogeneous nature of this disease hinders its diagnosis and treatment, requiring continuous advances in research aiming to understand its intricate nature. Consequently, the retrospective analysis of conventional therapies has allowed the introduction of novel tools provided by nanotechnology, leading to considerable improvements in clinical outcomes. Furthermore, the development of novel immunotherapies based on the recently understood interaction of the immune system with the tumor highlights the real possibility of definitively treating NSCLC from its early stages. Novel engineering approaches in nanomedicine will enable to overcome the intrinsic limits of conventional and emerging therapies regarding off-site cytotoxicity, specificity, resistance mechanisms, and administration issues. The convergence point of these therapies with nanotechnology lays the foundation for achieving currently unmet needs.
Collapse
Affiliation(s)
| | - Cristina Fornaguera
- Grup d’Enginyeria de Materials (GEMAT), Institut Químic de Sarrià (IQS), Universitat Ramon Llull (URL), 08022 Barcelona, Spain; (C.G.-F.); (S.B.)
| | | |
Collapse
|
42
|
Durawa A, Dziadziuszko K, Jelitto-Górska M, Szurowska E. Emphysema - The review of radiological presentation and its clinical impact in the LDCT screening era. Clin Imaging 2020; 64:85-91. [PMID: 32388002 DOI: 10.1016/j.clinimag.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/24/2020] [Accepted: 04/07/2020] [Indexed: 12/17/2022]
Abstract
Emphysema is one of three main lung pathologies in Chronic Obstructive Pulmonary Disease, along with chronic bronchitis and small airway obstruction. The diagnosis is based on detection of low attenuation areas in lung tissue on chest Computed Tomography, either visual by a radiologist, or automatic by the applied Computed Tomography software. Results of the studies on the association between emphysema and lung cancer incidence are mixed. Many studies have demonstrated, that chronic lung diseases, like Chronic Obstructive Pulmonary Disease, are associated with lung cancer morbidity. There is also evidence, that emphysema can be related with worse prognosis in patients with detected lung cancer. In this review article we aim to summarize current knowledge about emphysema detection and evaluation on Computed Tomography, both quantitative and qualitative. We also summarize current data on correlation between emphysema and lung cancer, as well as its potential use in selecting patients, who would most benefit from lung cancer screening.
Collapse
Affiliation(s)
- Agata Durawa
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland.
| | - Katarzyna Dziadziuszko
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland
| | - Małgorzata Jelitto-Górska
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland
| | - Edyta Szurowska
- 2nd Department of Radiology, Medical University of Gdansk, ul. Smoluchowskiego 17, 80-001 Gdansk, Poland
| |
Collapse
|
43
|
Li X, Xiao J, Huang M, Liu T, Guo L, Zeng W, Chen Q, Zhang J, Ma W. Associations of county-level cumulative environmental quality with mortality of chronic obstructive pulmonary disease and mortality of tracheal, bronchus and lung cancers. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 703:135523. [PMID: 31767293 DOI: 10.1016/j.scitotenv.2019.135523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/04/2019] [Accepted: 11/12/2019] [Indexed: 06/10/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) and tracheal, bronchus, and lung (TBL) cancers are among the leading causes of mortality worldwide. Many environmental factors have been linked to COPD and TBL cancers. This study examined the associations of cumulative environmental quality indices with COPD mortality and TBL cancers mortality, respectively. Environmental Quality Index (EQI) was constructed to represent cumulative environmental quality for the overall environment and 5 major environmental domains (e.g., air, water, built). Associations of each EQI indices with COPD mortality and TBL cancers mortality, across 3109 counties in the 48 contiguous states of the US, were examined using simultaneous autoregressive (SAR) models. Stratified analyses were conducted in females versus males and according to rural-urban continuum codes (RUCC) to assess the heterogeneity across the overall population. Overall poor environmental quality was associated with a percent difference (PD) of 0.75 [95% confidence intervals (95% CI), 0.46, 1.05] in COPD mortality and an PD of 1.22 (95% CI, 0.97, 1.46) in TBL cancers mortality. PDs were higher in females than in males for both COPD and TBL cancers. The built domain had the largest effect on COPD mortality (PD, 0.85; 95% CI, 0.58, 1.12) while the air domain had the largest effect on TBL cancers mortality (PD, 1.54; 95% CI, 1.31, 1.76). The EQI-mortality associations varied among different RUCCs, but no consistent trend was found. This result suggests that poor environmental quality, particularly poor air quality and built environment quality may increase the mortality risk for COPD and that for TBL cancers. Females appear to be more susceptible to the effect of cumulative environmental quality. Our findings highlight the importance of improving overall and domain-specific cumulative environmental quality in reducing COPD and TBL cancer mortalities in the United States.
Collapse
Affiliation(s)
- Xing Li
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China; Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Jianpeng Xiao
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Miaoling Huang
- Department of Obstetrics and Gynecology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510120, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Lingchuan Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Weilin Zeng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China
| | - Qing Chen
- Department of Epidemiology, School of Public Health, Southern Medical University, Guangzhou, Guangdong 510515, China.
| | - Junfeng Zhang
- Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, NC 27705, USA; Duke Kunshan University, Kunshan, Jiangsu Province 215316, China.
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, Guangdong 511430, China.
| |
Collapse
|
44
|
Humphries SM, Notary AM, Centeno JP, Strand MJ, Crapo JD, Silverman EK, Lynch DA. Deep Learning Enables Automatic Classification of Emphysema Pattern at CT. Radiology 2020; 294:434-444. [PMID: 31793851 PMCID: PMC6996603 DOI: 10.1148/radiol.2019191022] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 10/10/2019] [Indexed: 12/21/2022]
Abstract
BackgroundPattern of emphysema at chest CT, scored visually by using the Fleischner Society system, is associated with physiologic impairment and mortality risk.PurposeTo determine whether participant-level emphysema pattern could predict impairment and mortality when classified by using a deep learning method.Materials and MethodsThis retrospective analysis of Genetic Epidemiology of COPD (COPDGene) study participants enrolled between 2007 and 2011 included those with baseline CT, visual emphysema scores, and survival data through 2018. Participants were partitioned into nonoverlapping sets of 2407 for algorithm training, 100 for validation and parameter tuning, and 7143 for testing. A deep learning algorithm using convolutional neural network and long short-term memory architectures was trained to classify pattern of emphysema according to Fleischner criteria. Deep learning scores were compared with visual scores and clinical parameters including pulmonary function tests. Cox proportional hazard models were used to evaluate relationships between emphysema scores and survival. The algorithm was also tested by using CT and clinical data in 1962 participants enrolled in the Evaluation of COPD Longitudinally to Identify Predictive Surrogate End-points (ECLIPSE) study.ResultsA total of 7143 COPDGene participants (mean age ± standard deviation, 59.8 years ± 8.9; 3734 men and 3409 women) were evaluated. Deep learning emphysema classifications were associated with impaired pulmonary function tests, 6-minute walk distance, and St George's Respiratory Questionnaire at univariate analysis (P < .001 for each). Testing in the ECLIPSE cohort showed similar associations (P < .001). In the COPDGene test cohort, deep learning emphysema classification improved the fit of linear mixed models in the prediction of these clinical parameters compared with visual scoring (P < .001). Compared with participants without emphysema, mortality was greater in participants classified by the deep learning algorithm as having any grade of emphysema (adjusted hazard ratios were 1.5, 1.7, 2.9, 5.3, and 9.7, respectively, for trace, mild, moderate, confluent, and advanced destructive emphysema; P < .05).ConclusionDeep learning automation of the Fleischner grade of emphysema at chest CT is associated with clinical measures of pulmonary insufficiency and the risk of mortality.© RSNA, 2019Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Stephen M. Humphries
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Aleena M. Notary
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Juan Pablo Centeno
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Matthew J. Strand
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - James D. Crapo
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - Edwin K. Silverman
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - David A. Lynch
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| | - For the Genetic Epidemiology of COPD (COPDGene) Investigators
- From the Department of Radiology (S.M.H., A.M.N., J.P.C., D.A.L.), Division of Biostatistics and Bioinformatics (M.J.S.), and Department of Medicine (J.D.C.), National Jewish Health, 1400 Jackson St, Denver, CO 80206-2761; and Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, Mass (E.K.S.)
| |
Collapse
|
45
|
Wilson DO, de Torres JP. Lung cancer screening: how do we make it better? Quant Imaging Med Surg 2020; 10:533-536. [PMID: 32190580 DOI: 10.21037/qims.2020.01.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- David O Wilson
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | |
Collapse
|
46
|
Bhatt SP, Washko GR, Hoffman EA, Newell JD, Bodduluri S, Diaz AA, Galban CJ, Silverman EK, San José Estépar R, Lynch DA. Imaging Advances in Chronic Obstructive Pulmonary Disease. Insights from the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) Study. Am J Respir Crit Care Med 2019; 199:286-301. [PMID: 30304637 DOI: 10.1164/rccm.201807-1351so] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study, which began in 2007, is an ongoing multicenter observational cohort study of more than 10,000 current and former smokers. The study is aimed at understanding the etiology, progression, and heterogeneity of chronic obstructive pulmonary disease (COPD). In addition to genetic analysis, the participants have been extensively characterized by clinical questionnaires, spirometry, volumetric inspiratory and expiratory computed tomography, and longitudinal follow-up, including follow-up computed tomography at 5 years after enrollment. The purpose of this state-of-the-art review is to summarize the major advances in our understanding of COPD resulting from the imaging findings in the COPDGene study. Imaging features that are associated with adverse clinical outcomes include early interstitial lung abnormalities, visual presence and pattern of emphysema, the ratio of pulmonary artery to ascending aortic diameter, quantitative evaluation of emphysema, airway wall thickness, and expiratory gas trapping. COPD is characterized by the early involvement of the small conducting airways, and the addition of expiratory scans has enabled measurement of small airway disease. Computational advances have enabled indirect measurement of nonemphysematous gas trapping. These metrics have provided insights into the pathogenesis and prognosis of COPD and have aided early identification of disease. Important quantifiable extrapulmonary findings include coronary artery calcification, cardiac morphology, intrathoracic and extrathoracic fat, and osteoporosis. Current active research includes identification of novel quantitative measures for emphysema and airway disease, evaluation of dose reduction techniques, and use of deep learning for phenotyping COPD.
Collapse
Affiliation(s)
- Surya P Bhatt
- 1 UAB Lung Imaging Core and UAB Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Eric A Hoffman
- 3 Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - John D Newell
- 3 Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Sandeep Bodduluri
- 1 UAB Lung Imaging Core and UAB Lung Health Center, Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | | | - Craig J Galban
- 4 Department of Radiology and Center for Molecular Imaging, University of Michigan, Ann Arbor, Michigan; and
| | | | - Raúl San José Estépar
- 6 Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David A Lynch
- 7 Department of Radiology, National Jewish Health, Denver, Colorado
| |
Collapse
|
47
|
Nader CP, Cidem A, Verrills NM, Ammit AJ. Protein phosphatase 2A (PP2A): a key phosphatase in the progression of chronic obstructive pulmonary disease (COPD) to lung cancer. Respir Res 2019; 20:222. [PMID: 31623614 PMCID: PMC6798356 DOI: 10.1186/s12931-019-1192-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
Lung cancer (LC) has the highest relative risk of development as a comorbidity of chronic obstructive pulmonary disease (COPD). The molecular mechanisms that mediate chronic inflammation and lung function impairment in COPD have been identified in LC. This suggests the two diseases are more linked than once thought. Emerging data in relation to a key phosphatase, protein phosphatase 2A (PP2A), and its regulatory role in inflammatory and tumour suppression in both disease settings suggests that it may be critical in the progression of COPD to LC. In this review, we uncover the importance of the functional and active PP2A holoenzyme in the context of both diseases. We describe PP2A inactivation via direct and indirect means and explore the actions of two key PP2A endogenous inhibitors, cancerous inhibitor of PP2A (CIP2A) and inhibitor 2 of PP2A (SET), and the role they play in COPD and LC. We explain how dysregulation of PP2A in COPD creates a favourable inflammatory micro-environment and promotes the initiation and progression of tumour pathogenesis. Finally, we highlight PP2A as a druggable target in the treatment of COPD and LC and demonstrate the potential of PP2A re-activation as a strategy to halt COPD disease progression to LC. Although further studies are required to elucidate if PP2A activity in COPD is a causal link for LC progression, studies focused on the potential of PP2A reactivating agents to reduce the risk of LC formation in COPD patients will be pivotal in improving clinical outcomes for both COPD and LC patients in the future.
Collapse
Affiliation(s)
- Cassandra P Nader
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Aylin Cidem
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Nicole M Verrills
- School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia
- Priority Research Centre for Cancer Research, Innovation & Translation, Faculty of Health & Medicine, Hunter Medical Research Institute, New Lambton Heights, NSW, 2305, Australia
| | - Alaina J Ammit
- Woolcock Emphysema Centre, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.
- School of Life Sciences, Faculty of Science, University of Technology Sydney, Sydney, NSW, Australia.
| |
Collapse
|
48
|
Spiro SG, Shah PL, Rintoul RC, George J, Janes S, Callister M, Novelli M, Shaw P, Kocjan G, Griffiths C, Falzon M, Booton R, Magee N, Peake M, Dhillon P, Sridharan K, Nicholson AG, Padley S, Taylor MN, Ahmed A, Allen J, Ngai Y, Chinyanganya N, Ashford-Turner V, Lewis S, Oukrif D, Rabbitts P, Counsell N, Hackshaw A. Sequential screening for lung cancer in a high-risk group: randomised controlled trial: LungSEARCH: a randomised controlled trial of Surveillance using sputum and imaging for the EARly detection of lung Cancer in a High-risk group. Eur Respir J 2019; 54:13993003.00581-2019. [PMID: 31537697 PMCID: PMC6796151 DOI: 10.1183/13993003.00581-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening detects early-stage lung cancer and reduces mortality. We proposed a sequential approach targeted to a high-risk group as a potentially efficient screening strategy. METHODS LungSEARCH was a national multicentre randomised trial. Current/ex-smokers with mild/moderate chronic obstructive pulmonary disease (COPD) were allocated (1:1) to have 5 years surveillance or not. Screened participants provided annual sputum samples for cytology and cytometry, and if abnormal were offered annual LDCT and autofluorescence bronchoscopy (AFB). Those with normal sputum provided annual samples. The primary end-point was the percentage of lung cancers diagnosed at stage I/II (nonsmall cell) or limited disease (small cell). RESULTS 1568 participants were randomised during 2007-2011 from 10 UK centres. 85.2% of those screened provided an adequate baseline sputum sample. There were 42 lung cancers among 785 screened individuals and 36 lung cancers among 783 controls. 54.8% (23 out of 42) of screened individuals versus 45.2% (14 out of 31) of controls with known staging were diagnosed with early-stage disease (one-sided p=0.24). Relative risk was 1.21 (95% CI 0.75-1.95) or 0.82 (95% CI 0.52-1.31) for early-stage or advanced cancers, respectively. Overall sensitivity for sputum (in those randomised to surveillance) was low (40.5%) with a cumulative false-positive rate (FPR) of 32.8%. 55% of cancers had normal sputum results throughout. Among sputum-positive individuals who had AFB, sensitivity was 45.5% and cumulative FPR was 39.5%; the corresponding measures for those who had LDCT were 100% and 16.1%, respectively. CONCLUSIONS Our sequential strategy, using sputum cytology/cytometry to select high-risk individuals for AFB and LDCT, did not lead to a clear stage shift and did not improve the efficiency of lung cancer screening.
Collapse
Affiliation(s)
- Stephen G Spiro
- Dept of Respiratory Medicine, University College Hospital, London, UK.,These authors are joint lead authors
| | - Pallav L Shah
- Dept of Respiratory Medicine, Royal Brompton Hospital, Chelsea and Westminster Hospital and Imperial College London, London, UK
| | - Robert C Rintoul
- Dept of Oncology, Royal Papworth Hospital and University of Cambridge, Cambridge, UK
| | - Jeremy George
- UCL Respiratory, Dept of Medicine, University College London, London, UK
| | - Samuel Janes
- UCL Respiratory, Dept of Medicine, University College London, London, UK
| | - Matthew Callister
- Dept of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marco Novelli
- Cellular Pathology, University College Hospital, London, UK
| | - Penny Shaw
- Radiology (Imaging), University College Hospital, London, UK
| | | | - Chris Griffiths
- Institute of Population Health Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Mary Falzon
- Cellular Pathology, University College Hospital, London, UK
| | - Richard Booton
- Lung Cancer and Thoracic Surgery Directorate, Manchester University NHS Trust and University of Manchester, Manchester, UK
| | - Nicholas Magee
- Respiratory Medicine, Belfast City Hospital, Belfast, UK
| | - Michael Peake
- Dept of Immunity, Infection and Inflammation, University of Leicester, Leicester, UK.,Centre for Cancer Outcomes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Paul Dhillon
- Respiratory Medicine, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Kishore Sridharan
- Dept of Thoracic Medicine, Sunderland Royal Hospital, Sunderland, UK
| | - Andrew G Nicholson
- Dept of Histopathology, Royal Brompton Hospital and Harefield NHS Foundation Trust and National Heart and Lung Institute, London, UK
| | - Simon Padley
- Radiology, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College London, London, UK
| | - Magali N Taylor
- Radiology (Imaging), University College Hospital, London, UK
| | - Asia Ahmed
- Radiology (Imaging), University College Hospital, London, UK
| | - Jack Allen
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | - Yenting Ngai
- Cancer Research UK and UCL Cancer Trials Centre, London, UK
| | | | | | - Sarah Lewis
- Research and Development, Royal Papworth Hospital, Cambridge, UK
| | - Dahmane Oukrif
- Dept of Pathology, University College Hospital, London, UK
| | - Pamela Rabbitts
- Leeds Institute of Cancer and Pathology (LICAP), University of Leeds, Leeds, UK
| | | | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, London, UK.,These authors are joint lead authors
| |
Collapse
|
49
|
Li Z, Xia Y, Fang Y, Guan Y, Wang Y, Liu S, Fan L. The importance of CT quantitative evaluation of emphysema in lung cancer screening cohort with negative findings by visual evaluation. CLINICAL RESPIRATORY JOURNAL 2019; 13:741-750. [PMID: 31444943 DOI: 10.1111/crj.13084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 08/12/2019] [Accepted: 08/16/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION One-stop quantitative evaluation of emphysema and lung nodule in lung cancer screening is very important for patient. OBJECTIVE To evaluate the quantitative emphysema in the large-sample low-dose CT lung cancer screening cohort with negative CT findings by subjective visual assessment. METHODS One thousand, two hundred and thirty-one participants with negative visual evaluation were included in this retrospective study. The lungs were automatically segmented and the following were calculated: total lung volume (TLV), total emphysema volume (TEV), emphysema index (EI), 15th percentile lung density and mean lung density. EI ≥6% was defined as emphysema. The quantitative parameters were compared between different genders and ages. The quantitative parameters and risk factors were compared between emphysema and non-emphysema groups. RESULTS The proportion of smokers, TLV, TEV and EI of men were greater than that of women (P < 0.001). No correlation was found between age and volumes; the TEV and EI of people older than 60 years were greater than those younger than 60 years (P < 0.05) by age categorisation. One hundred and two participants showed emphysema, accounting for 8.29%. The incidence of emphysema in men was greater than that in women in total (P < 0.05). All the CT quantitative parameters were significantly different between emphysema and non-emphysema groups. The ratio of male, secondhand smoke exposure and chronic bronchitis history was greater in emphysema than that in the non-emphysema group (P < 0.05). CONCLUSION CT quantitative emphysema evaluation is recommended in people older than 60 years, especially in males, providing more precise information, aiding the early diagnosis of emphysema and informing early intervention.
Collapse
Affiliation(s)
- Zhaobin Li
- Department of Radiation Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yi Xia
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yuan Fang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China.,The 73049 PLA Hospital, Suzhou, China
| | - Yu Guan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yun Wang
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shiyuan Liu
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Li Fan
- Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| |
Collapse
|
50
|
Young RP, Hopkins R. The potential impact of chronic obstructive pulmonary disease in lung cancer screening: implications for the screening clinic. Expert Rev Respir Med 2019; 13:699-707. [PMID: 31274043 DOI: 10.1080/17476348.2019.1638766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Following the findings of the National Lung Screening Trial (NLST), lung cancer screening is now recommended in the United States. However, post-hoc analyses of the NLST suggest that reducing lung cancer mortality through screening is highly dependent on the underlying characteristics of the screening participants, in particular, the presence of chronic obstructive pulmonary disease (COPD). Areas covered: In this review, we outline how outcomes in lung cancer screening are significantly affected by the presence of airflow limitation, as caused by COPD, and how this might impact the assessment of eligible smokers in a lung cancer screening clinic. Expert opinion: There is growing evidence showing that CT-based screening for lung cancer reduces lung cancer mortality. The benefits of screening exceed those seen in the NLST when screening is carried out in lower risk populations, for a longer duration, and when outcomes are compared with usual care control cohorts. In this article, we review data from a post-hoc analysis of the NLST. We suggest that whilst worsened airflow limitation is associated with greater lung cancer risk, there is also more aggressive lung cancer, reduced lung cancer operability, and for advanced COPD, reduced benefits from screening. We advocate an 'outcomes-based' approach to screening over a 'risk-based' approach.
Collapse
Affiliation(s)
- Robert P Young
- a School of Biological Sciences, University of Auckland , Auckland , New Zealand.,b Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
| | - Raewyn Hopkins
- b Faculty of Medical and Health Sciences, University of Auckland , Auckland , New Zealand
| |
Collapse
|