Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients
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RESEARCH ARTICLE
Open Access
Regional emphysema score is associated with tumor location and poor prognosis in completely resected NSCLC patients Jung Won Heo1, Hye Seon Kang2, Chan Kwon Park3, Sung Kyoung Kim4, Ju Sang Kim5, Jin Woo Kim6, Seung Joon Kim7, Sang Haak Lee1 and Chang Dong Yeo1*
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. Keywords: Lung cancer, Location, Prognosis, Regional emphysema, Visual score
* Correspondence: [email protected] 1 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 Full list of author information is available at the end of the article
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