The Egyptian Journal of Bronchology
JUNE 2010 |
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ORIGINAL ARTICLE
COPD AS AN INDEPENDENT RISK FACTOR FOR LUNG CANCER IN PATIENTS WITH BRONCHIAL SQUAMOUS DYSPLASIA
By
Mohamed Alaa,1,3 Kiyoshi Shibuya,1 Hidehisa Hoshino,1 Yasumitsu Moriya,1 Shigetoshi Yoshida,1 Makoto Suzuki,1 Kenzo Hiroshima,2 Yukio Nakatani,2 Aliae Mohamed-Hussein,3 Maha Elkholy,3 Tarek Mahfouz,3
Ichiro Yoshino1
1Departments of Thoracic Surgery, 2Diagnostic Pathology, Graduate School of Medicine, Chiba University, Chiba, Japan, 3Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Assiut University, Assiut, Egypt
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Background:
We evaluated airflow obstruction as a possible independent risk factor for lung cancer (LC) in patients with bronchial squamous dysplasia (SD).
Methods:
A total of 114 patients (111 men and 3 women) with at least 1 bronchial SD, at least 1 follow-up evaluation and normal baseline chest computed tomography (CT) were evaluated; 58 (51%) were COPD and 56 (49%) were non-COPD patients. Median age was 68 years (range,44–84 yr) and median follow-up duration was 21 months (range,4-98 months). Follow-up included periodic white light and autofluorescence bronchoscopy and chest CT. Expression of iNOS (inducible nitric oxide synthase) and EGFR (epidermal growth factor receptor) in bronchial epithelium biopsy specimens was evaluated by immunohistochemistry (IHC). Diagnosis of carcinoma in situ (CIS) and/or LC were follow-up endpoints.
Results:
Expression of iNOS and EGFR was closely related to patient COPD status (p=0.007 and p=0.018, respectively). COPD patients were more likely to have baseline high grade dysplasia (p=0.017), multiple dysplasias (p=0.045) and to develop a new dysplasia during follow-up (p=0.003). Progression to CIS or LC occurred more frequently in patients with COPD (p=0.012), positive EGFR (p=0.019), positive iNOS (p<0.001) and baseline high grade SD (p=0.035). Multivariate analysis showed that risk for progression was closely related to airflow obstruction (RR=0.959; 95% CI=0.923-0.997; p=0.044) and iNOS expression (RR=10.521; 95% CI=2.75-40.3; p=0.001).
Conclusion:
In patients with bronchial SD, COPD is closely related to risk of progression to CIS or LC. This study supports the hypothesis that inflammation and oxidative stress promote lung carcinogenesis.
Abbreviations: COPD= Chronic obstructive pulmonary disease. INOS= Inducible nitric oxide synthase, EGFR= Epidermal growth factor receptor, LC= Lung cancer, SD= Squamous dysplasia, SqCC= Squamous cell carcinoma, RR= Relative risk, CI= Confidence interval.
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