title: Relationship Between Emphysema Severity and the Location of Lung Cancer in Patients With Chronic Obstructive Lung Disease.
abstract: OBJECTIVE
  New phenotypes of chronic obstructive pulmonary disease (COPD) based on emphysema severity have been recognized recently. The purpose of this study was to determine the relationship between emphysema severity (phenotype) and lung cancer location in patients with COPD.
  
  
  METHODS
  Four hundred patients with 405 primary lung cancers confirmed pathologically between January 2010 and March 2014 were included in the study. Of these, 193 patients received a diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. We scored emphysema severity (0-4) on thin-section CT and assigned the anatomic tumor location of lung cancer as peripheral or central.
  
  
  RESULTS
  Patients with COPD had a higher proportion of centrally located lung cancer compared with those without COPD (36.4% vs 17.4%; p < 0.001). In patients with COPD, lower emphysema grades (odds ratio [OR], 0.69; 95% CI, 0.51-0.93; p = 0.016) and reduced ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) (OR, 0.94; 95% CI, 0.89-0.99; p = 0.024) were associated with central location. After adjusting for age, smoking, and spirometry results, the proportion of central location was approximately four times higher in patients with lower emphysema grades (0-2, < 25%) than in those with severe grades (grade 4, > 51%).
  
  
  CONCLUSIONS
  Lower emphysema grades and reduced FEV1/FVC seemed to be independent predictors of central location of lung cancer in COPD. Therefore, in patients with COPD with lower grade emphysema and airway-predominant disease, additional screening tools may have to be considered for central lung cancer detection along with thin-section CT.
authors: 1 Department of Preventive Medicine, Eulji University School of Medicine, Daejeon, Korea.
authors: Jiseun
authors: J
authors: Lim
authors: 2 Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, 807, Hoguk-ro, Buk-gu, Daegu 702-210, Korea.
authors: Kyung Min
authors: KM
authors: Shin
authors: 3 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors: KyungSoo
authors: K
authors: Lee
authors: 2 Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, 807, Hoguk-ro, Buk-gu, Daegu 702-210, Korea.
authors: Jae Kwang
authors: JK
authors: Lim
authors: 2 Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, 807, Hoguk-ro, Buk-gu, Daegu 702-210, Korea.
authors: Hye Jung
authors: HJ
authors: Kim
authors: 2 Department of Radiology, Kyungpook National University Medical Center, Kyungpook National University School of Medicine, 807, Hoguk-ro, Buk-gu, Daegu 702-210, Korea.
authors: Seung Hyun
authors: SH
authors: Cho
authors: 4 Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea.
authors: Seung Ick
authors: SI
authors: Cha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011656:Pulmonary Emphysema / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D011857:Radiographic Image Interpretation, Computer-Assisted; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
keywords: chronic obstructive pulmonary disease; emphysema; lung cancer