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Initial CDAS Request Approval
May 29, 2008
CT Assessment of Emphysema, Airways, and Lung Cancer Risk
Chronic obstructive pulmonary disease (COPD) resulting from cigarette smoking has been associated with up to a more than two-fold increased risk of lung cancer. In addition, lung cancer has been found in up to 5% of patients with advanced COPD who are treated by lung volume reduction surgery. Airflow obstruction, which is the common denominator that defines COPD, is a result of two primary pathologic abnormalities occurring in COPD: emphysema (airspace enlargement and tissue destruction) and bronchitis (airways disease). Although multiple studies have found that expiratory airflow impairment is associated with lung cancer, those that have investigated whether emphysema has an independent association with lung cancer have produced conflicting results. While airway dimensions (characterized by cross-sectional wall and lumen diameter and area) have been correlated with the degree of airflow obstruction in COPD, to our knowledge it is unknown whether airway dimensions are related to lung cancer risk. We propose this study to see whether emphysema and airway morphology, quantified from screening CT scans, may be risk factors for lung cancer development and progression in the NLST population.
Aim 1: Compare emphysema severity and airway dimensions on the screening CT scans of matched cohorts of NLST participants with and without known lung cancer, and determine whether the CT parameters are associated with an increased risk of lung cancer 2. Determine whether there is an association between CT-measured emphysema severity, CT-measured airway morphology, and the recorded number of noncalcified pulmonary nodules =4 mm 3. Correlate emphysema severity and airway morphology with lung cancer stage and outcome (This Aim will be pursued only if the results of Aims 1 and 2 are promising, and results would not be published prior to primary trial outcomes)