COPD患者肺气肿Goddard评分和肺癌发生部位的相关性研究

The relationship between emphysema severity and location of lung cancer in patients with chronic obstructive lung disease

目的研究慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者肺气肿的严重程度和肺癌发生部位的相关性。方法收集肺癌的患者101例,其中伴COPD的肺癌患者49例。在薄层CT对肺气肿严重程度进行评分(0~4),并将肺癌分为周围型和中心型。结果伴COPD的肺癌患者,年龄,男性,肺气肿的发病率和严重程度高于不伴COPD的肺癌患者,且差异有统计学意义。COPD患者比非COPD患者具有高比例的中心型肺癌(49.0%,28.8%,P<0.05)。COPD低肺气肿级别(0~2,<25%)患者较高肺气肿级别患者(3~4,>26%)发生中心型肺癌的比例高(57.9%,18.2%,P<0.05)。结论 COPD患者比不伴COPD患者肺癌更倾向于中心型,低肺气肿级别可能是COPD患者发生中心型肺癌的预测因子。因此,COPD患者中具有低级别肺气肿(气道为主)者,行薄层CT检查的同时,痰检和支气管镜可能用来早期发现肿瘤。

Objective The purpose of this study was to determine the relationship between emphysema severity and location of lung cancer in patients with COPD. Methods 101 patients with primary lung cancers were included in the study. Of these, 49 patients were with COPD. The emphysema severity were scored （0 - 4） on thinsection CT and the location of lung cancer was as- signed as peripheral or central. Results Patients with COPD had a higher proportion of age, male, incidence and severity of em- physema compared with those without COPD, and the difference was of statistically significant. Patients with COPD had a higher proportion of centrally located lung cancer （49.0% vs 28.8% , P 〈0.05 ）. In patients with COPD, the proportion of central lo- cation was higher in patients with lower emphysema grades （0 -2, 〈 25% ） than in those with higher grades （3 ~ 4, 〉 26% ） （ 57.9% vs 18.2%, P 〈 0.05 ）. Conclusion The lung cancers in patients with COPD tended to be centrally located compared with patients without COPD. Lower emphysema grades seemed to be predictors of central location of lung cancer in COPD. There- fore, in patients with COPD with lower grade emphysema（ airway-predominant disease）, sputum and bronchoscopy may have to be considered for central lung cancer detection along with thin-section CT in order to detect of cancer earlier.