肺癌筛查试验中肺部结节和肺气肿同时存在与肺癌风险的关系

IF 2.1 Q3 ONCOLOGY
World Journal of Oncology Pub Date : 2024-04-01 Epub Date: 2024-03-21 DOI:10.14740/wjon1782
Ya Liu, Zhuo Wei Feng, Xiao Min Liu, Hong Yuan Duan, Zhang Yan Lyu, Yu Bei Huang, Fang Fang Song, Feng Ju Song
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引用次数: 0

摘要

背景:肺气肿和肺结节同时存在可能会相互影响,进而导致潜在的肺癌风险升高。本研究旨在探讨肺气肿合并肺结节与肺癌风险之间的关系:研究共纳入了 21949 名接受过低剂量计算机断层扫描(LDCT)检查的全国肺筛查试验(NLST)参与者。根据是否存在肺结节和肺气肿将参与者分为四组(NENN 组(无肺气肿和无结节)、E 组(无结节的肺气肿)、N 组(无肺气肿的结节)和 E + N 组(有肺气肿的结节))。通过多变量考克斯回归和分层分析来估计四个组别与肺癌风险之间的关系:在21949名参与者中,NENN组、E组、N组和E+N组分别有9040人(41.2%)、5819人(26.5%)、4737人(21.6%)和2353人(10.7%)。在 NENN 组、E 组、N 组和 E + N 组中,肺癌发病风险依次增加。与 NENN 组相比,E 组经年龄调整后的肺癌发病危险比(HRs)(95% 置信区间(CIs))为 2.07(1.69 - 2.54),N 组为 4.13(3.47 - 5.05),E + N 组为 6.26(5.14 - 7.62)。对潜在的混杂因素进行调整后,这种关联仍很稳健(E 组为 1.83(1.47 - 2.27),N 组为 3.97(3.24 - 4.86),E + N 组为 5.23(4.28 - 6.48))。在肺癌死亡率方面,也观察到了与肺癌发病率相似的结果,无论是在年龄调整模型中(E 组:1.85 (1.39 - 2.46),N 组:2.49 (1.89 - 3.29),E + N 组:4.27 (3.21 - 6.48):4.27 (3.21 - 5.68))或完全调整模型(E 组:1.56 (1.15 - 5.68)):1.56 (1.15 - 2.11),N 组:2.43 (1.81 - 3.26),E + N 组:3.39 (2.50 - 5.68):3.39 (2.50 - 4.61)).然而,无论是在年龄调整模型中(E 组:1.37(1.21 - 1.54),N 组:1.06(0.92 - 1.21),E + N 组为 1.75(1.51 - 2.02))或完全调整模型(E 组为 1.26(1.10 - 1.44),N 组为 1.09(0.94 - 1.27),E + N 组为 1.52(1.30 - 1.79)):该研究基于美国的一项大规模肺癌筛查试验,证明肺气肿或肺结节都会增加肺癌风险,而肺结节合并肺气肿会进一步增加肺癌风险和全因死亡率。应评估这些发现对肺癌筛查的意义。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of Lung Cancer Risk With the Presence of Both Lung Nodules and Emphysema in a Lung Cancer Screening Trial.

Background: The coexistence of emphysema and lung nodules could interact with each other and then lead to potential higher lung cancer risk. The study aimed to explore the association between emphysema combined with lung nodules and lung cancer risk.

Methods: A total of 21,949 participants from the National Lung Screening Trial (NLST) who underwent low-dose computed tomography (LDCT) examination were included. Participants were categorized into four groups (NENN group (non-emphysema and non-nodules), E group (emphysema without nodules), N group (nodules without emphysema), and E + N group (nodules with emphysema)) according to whether there were lung nodules and emphysema. Multivariable Cox regression and stratified analyses were performed to estimate the association between the four groups and lung cancer risk.

Results: Among the 21,949 participants, there were 9,040 (41.2%), 5,819 (26.5%), 4,737 (21.6%), and 2,353 (10.7%) participants in the NENN group, E group, N group, and E + N group. The risk of lung cancer incidence increased in turn in NENN group, E group, N group and E + N group. Compared with NENN group, the age-adjusted hazard ratios (HRs) (95% confidence intervals (CIs)) of lung cancer incidence were 2.07 (1.69 - 2.54) for E group, 4.13 (3.47 - 5.05) for N group, and 6.26 (5.14 - 7.62) for E + N group. The association was robust to adjustment for potential confounders (1.83 (1.47 - 2.27) for E group, 3.97 (3.24 - 4.86) for N group, and 5.23 (4.28 - 6.48) for E + N group). Comparable results as the lung cancer incidence were observed for lung cancer mortality, whether in age-adjusted model (E group: 1.85 (1.39 - 2.46), N group: 2.49 (1.89 - 3.29), E + N group: 4.27 (3.21 - 5.68)) or fully adjusted model (E group: 1.56 (1.15 - 2.11), N group: 2.43 (1.81 - 3.26), E + N group: 3.39 (2.50 - 4.61)). However, the trend of all-cause mortality risk among the four groups was somewhat different from that of lung cancer risk, whether in age-adjusted model (1.37 (1.21 - 1.54) for E group, 1.06 (0.92 - 1.21) for N group, and 1.75 (1.51 - 2.02) for E + N group) or fully adjusted model (1.26 (1.10 - 1.44) for E group, 1.09 (0.94 - 1.27) for N group, and 1.52 (1.30 - 1.79) for E + N group).

Conclusion: Based on a large-scale lung cancer screening trial in the United States, this study demonstrated that either emphysema or lung nodules can increase lung cancer risk, and lung nodules combined with emphysema can further increase the lung cancer risk and all-cause mortality. The significance of these findings for lung cancer screening should be evaluated.

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来源期刊
CiteScore
6.10
自引率
15.40%
发文量
37
期刊介绍: World Journal of Oncology, bimonthly, publishes original contributions describing basic research and clinical investigation of cancer, on the cellular, molecular, prevention, diagnosis, therapy and prognosis aspects. The submissions can be basic research or clinical investigation oriented. This journal welcomes those submissions focused on the clinical trials of new treatment modalities for cancer, and those submissions focused on molecular or cellular research of the oncology pathogenesis. Case reports submitted for consideration of publication should explore either a novel genomic event/description or a new safety signal from an oncolytic agent. The areas of interested manuscripts are these disciplines: tumor immunology and immunotherapy; cancer molecular pharmacology and chemotherapy; drug sensitivity and resistance; cancer epidemiology; clinical trials; cancer pathology; radiobiology and radiation oncology; solid tumor oncology; hematological malignancies; surgical oncology; pediatric oncology; molecular oncology and cancer genes; gene therapy; cancer endocrinology; cancer metastasis; prevention and diagnosis of cancer; other cancer related subjects. The types of manuscripts accepted are original article, review, editorial, short communication, case report, letter to the editor, book review.
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