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      The impact of emphysema on surgical outcomes of early-stage lung cancer: a retrospective study

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          Abstract

          Background

          The presence of emphysema on computed tomography (CT) is associated with an increased frequency of lung cancer, but the postoperative outcomes of patients with pulmonary emphysema are not well known. The objective of this study was to investigate the association between the extent of emphysema and long-term outcomes, as well as mortality and postoperative complications, in early-stage lung cancer patients after pulmonary resection.

          Methods

          The clinical records of 566 consecutive lung cancer patients who underwent pulmonary resection in our department were retrospectively reviewed. Among these, the data sets of 364 pathological stage I patients were available. The associations between the extent of lung emphysema and long-term outcomes and postoperative complications were investigated. Emphysema was assessed on the basis of semiquantitative CT. Surgery-related complications of Grade ≥ II according to the Clavien-Dindo classification were included in this study.

          Results

          Emphysema was present in 63 patients. The overall survival and relapse-free survival of the non-emphysema and emphysema groups at 5 years were 89.0 and 61.3% ( P < 0.001), respectively, and 81.0 and 51.7%, respectively ( P < 0.001). On multivariate analysis, significant prognostic factors were emphysema, higher smoking index, and higher histologic grade ( p < 0.05). Significant risk factors for poor recurrence-free survival were emphysema, higher smoking index, higher histologic grade, and presence of pleural invasion ( P < 0.05). Regarding Grade ≥ II postoperative complications, pneumonia and supraventricular tachycardia were more frequent in the emphysema group than in the non-emphysema group ( P = 0.003 and P = 0.021, respectively).

          Conclusion

          The presence of emphysema affects the long-term outcomes and the development of postoperative complications in early-stage lung cancer patients.

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          Most cited references43

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            The new lung cancer staging system.

            The International Association for the Study of Lung Cancer (IASLC) has conducted an extensive initiative to inform the revision of the lung cancer staging system. This involved development of an international database along with extensive analysis of a large population of patients and their prognoses. This article reviews the recommendations of the IASLC International Staging Committee for the definitions for the TNM descriptors and the stage grouping in the new non-small cell lung cancer staging system.
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              Assessing the relationship between lung cancer risk and emphysema detected on low-dose CT of the chest.

              Identification of risk factors for lung cancer can help in selecting patients who may benefit the most from smoking cessation interventions, early detection, or chemoprevention. To evaluate whether the presence of emphysema on low-radiation-dose CT (LDCT) of the chest is an independent risk factor for lung cancer. The study used data from a prospective cohort of 1,166 former and current smokers participating in a lung cancer screening study. All individuals underwent a baseline LDCT and spirometry followed by yearly repeat LDCT studies. The incidence density of lung cancer among patients with and without emphysema on LDCT was estimated. Stratified and multiple regression analyses were used to assess whether emphysema is an independent risk factor for lung cancer after adjusting for age, gender, smoking history, and the presence of airway obstruction on spirometry. On univariate analysis, the incidence density of lung cancer among individuals with and without emphysema on LDCT was 25.0 per 1,000 person-years and 7.5 per 1,000 person-years, respectively (risk ratio [RR], 3.33; 95% confidence interval [CI], 1.41 to 7.85). Emphysema was also associated with increased risk of lung cancer when the analysis was limited to individuals without airway obstruction on spirometry (RR, 4.33; 95% CI, 1.04 to 18.16). Multivariate analysis showed that the presence of emphysema (RR, 2.51; 95% CI, 1.01 to 6.23) on LDCT but not airway obstruction (RR, 2.10; 95% CI, 0.79 to 5.58) was associated with increased risk of lung cancer after adjusting for potential cofounders. Results suggest that the presence of emphysema on LDCT is an independent risk factor for lung cancer.
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                Author and article information

                Contributors
                +81-25227-2243 , seisato@med.niigata-u.ac.jp
                white_bass_23@yahoo.co.jp
                yukismz0612@gmail.com
                moyoco03120508@yahoo.co.jp
                t-koike@kj8.so-net.ne.jp
                iskw@med.niigata-u.ac.jp
                masatsu@med.niigata-u.ac.jp
                Journal
                BMC Pulm Med
                BMC Pulm Med
                BMC Pulmonary Medicine
                BioMed Central (London )
                1471-2466
                4 April 2019
                4 April 2019
                2019
                : 19
                : 73
                Affiliations
                [1 ]ISNI 0000 0001 0671 5144, GRID grid.260975.f, Division of Thoracic and Cardiovascular Surgery, , Niigata University Graduate School of Medical and Dental Sciences, ; 1-757 Asahimachi-dori, Chuo-ku, Niigata-shi, Niigata, 951-8510 Japan
                [2 ]ISNI 0000 0001 0671 5144, GRID grid.260975.f, Department of Radiology and Radiation Oncology, , Niigata University Graduate School of Medical and Dental Sciences, ; Niigata, Japan
                Article
                839
                10.1186/s12890-019-0839-1
                6449985
                30947705
                bd91b8e0-27c4-4f68-bc33-1771968a0757
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 25 October 2018
                : 27 March 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Respiratory medicine
                lung cancer,emphysema,pulmonary resection,prognosis,postoperative complications

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