The association and impact of radiographic, pathological emphysema and spirometric airway obstruction on patients with resectable lung adenocarcinoma.

IF 5.8 2区医学 Q1 Medicine

Respiratory Research Pub Date : 2025-04-16 DOI:10.1186/s12931-025-03225-6

Yixiao Zhang, Lu Lang, Xiaojuan Guo, Kewu Huang, Jiawen Yi, Yuan Yuan, Min Zhu, Shu Zhang, Bin Hu, Xue Li, Yuhui Zhang

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引用次数: 0

Abstract

Background: Destruction of alveoli structure and lung function are interrelated, however, their correlation and clinical significance have been not well defined in patients with lung cancer. Thus, this study aimed to examine the association among radiographic, pathological emphysema and spirometric airway obstruction in patients with resectable lung cancer as well as explore their impact on postoperative pulmonary complications (PPCs) and long-term prognosis.

Methods: Lung adenocarcinoma (LUAD) patients who performed chest CT, spirometry, and curative resection were included from a prospective three-institution database. CT-defined emphysema at baseline was assessed visually and quantitatively, pathological emphysema was reviewed on postoperative specimen. Multivariable regression models, propensity score matching, stratified analysis, and subgroup analysis were adopted to reduce selection bias.

Results: Our cohort included 902 patients, with a median follow-up of 5.6 years. CT-defined emphysema was present in 163 patients (18.1%) and most of them (86.5%) were validated with pathological evidence. 169 had spirometric airway obstruction, while only 29.6% patients overlapped with CT-defined emphysema. Multivariable logistic regression models showed CT-defined emphysema, not airway obstruction, was associated with an increased risk of PPCs (adjusted odds ratio, 2.35; 95% CI, 1.40-3.93; P = 0.001). After adjusting for age, sex, body mass index, smoking history, tumour stage, vascular invasion, pleural invasion, multivariate cox analysis identified CT-defined emphysema, not airway obstruction, as an independent prognostic factor for OS (adjusted hazard ratio, 1.44; 95%CI, 1.05-1.97; P = 0.022). Patients with both radiographic and pathological emphysema experienced worse OS (log-rank P < 0.001). In the propensity score-matched cohort, stratified analysis, and never-smokers subgroup analysis, CT-defined emphysema remained a strong and statistically significant factor related to poor survival.

Conclusions: The presence of radiological and pathological emphysema in resectable LUAD was associated with frequent PPCs and decreased survival.

Clinical trial number: Not applicable.

查看原文本刊更多论文

放射学、病理性肺气肿和肺活量计气道阻塞与可切除肺腺癌患者的关系和影响。

背景：肺泡结构破坏与肺功能之间存在相关性，但其在肺癌患者中的相关性及临床意义尚未明确。因此，本研究旨在探讨可切除肺癌患者的影像学、病理性肺气肿和肺量计气道阻塞之间的关系，以及它们对术后肺部并发症（PPCs）和长期预后的影响。方法：肺腺癌（LUAD）患者进行了胸部CT，肺活量测定和治愈性切除，从前瞻性三机构数据库中纳入。对基线时ct定义的肺气肿进行视觉定量评估，术后标本对病理肺气肿进行复查。采用多变量回归模型、倾向评分匹配、分层分析、亚组分析等方法减少选择偏倚。结果：我们的队列包括902例患者，中位随访时间为5.6年。163例（18.1%）患者存在ct定义的肺气肿，其中大多数（86.5%）经病理证实。169例有肺活量计的气道阻塞，而只有29.6%的患者与ct定义的肺气肿重叠。多变量logistic回归模型显示，ct定义的肺气肿与PPCs风险增加相关，而不是气道阻塞(校正优势比为2.35；95% ci, 1.40-3.93；p = 0.001)。在调整了年龄、性别、体重指数、吸烟史、肿瘤分期、血管侵犯、胸膜侵犯等因素后，多因素cox分析发现，ct定义的肺气肿，而不是气道阻塞，是OS的独立预后因素(调整后的风险比为1.44；95%置信区间,1.05 - -1.97;p = 0.022)。放射学和病理性肺气肿患者的OS更差（log-rank P）。结论：可切除LUAD中放射学和病理性肺气肿的存在与PPCs的频繁发生和生存率降低有关。临床试验号：不适用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Respiratory Research RESPIRATORY SYSTEM-

CiteScore

9.70

自引率

1.70%

发文量

314

审稿时长

4-8 weeks

期刊介绍： Respiratory Research publishes high-quality clinical and basic research, review and commentary articles on all aspects of respiratory medicine and related diseases. As the leading fully open access journal in the field, Respiratory Research provides an essential resource for pulmonologists, allergists, immunologists and other physicians, researchers, healthcare workers and medical students with worldwide dissemination of articles resulting in high visibility and generating international discussion. Topics of specific interest include asthma, chronic obstructive pulmonary disease, cystic fibrosis, genetics, infectious diseases, interstitial lung diseases, lung development, lung tumors, occupational and environmental factors, pulmonary circulation, pulmonary pharmacology and therapeutics, respiratory immunology, respiratory physiology, and sleep-related respiratory problems.