Factors Associated With Small Aggressive Non–Small Cell Lung Cancers in the National Lung Screening Trial: A Validation Study

JNCI Cancer Spectrum

Commins, John¹  Ragard, Lawrence R²  Tammemägi, Martin C³  Hu, Ping³  Kvale, Paul A⁴  Warkentin, Matthew T⁵  Freedman, Matthew T⁵  Riley, Thomas L⁶  Brenner, Darren R⁷  Berg, Christine D⁸  Church, Timothy R⁸  Hocking, William G⁹ 

[1] Biometry Research Group, National Cancer Institute, Bethesda, MD;Cancer Prevention and Control, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC;Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada;Department of Clinical Oncology, Marshfield Clinic Health System, Marshfield, WI;Department of Health Sciences, Brock University, St. Catharine’s, Ontario, Canada;Departments of Community Health Sciences and Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada;Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI;Information Management Services, Inc., Rockville, MD;Westat, Rockville, MD

关键词: non-small-cell lung carcinoma;    lung cancer;    nlst trial;    neoplasm metastasis;    lung;    carcinogenesis;    transverse spin relaxation time;    lymph nodes;    hormones;    follow-up;   

DOI  :  10.1093/jncics/pkx010

学科分类：肿瘤学

来源: Oxford University Press

【 摘 要 】

BackgroundA small proportion of non–small cell lung cancers (NSCLCs) have been observed to spread to distant lymph nodes (N3) or metastasize (M1) or both, while the primary tumor is small (≤3 cm, T1). These small aggressive NSCLCs (SA-NSLSC) are important as they are clinically significant, may identify unique biologic pathways, and warrant aggressive follow-up and treatment. This study identifies factors associated with SA-NSCLC and attempts to validate a previous finding that women with a family history of lung cancer are at particularly elevated risk of SA-NSCLC.MethodsThis study used a case–case design within the National Cancer Institute’s National Lung Screening Trial (NLST) cohort. Case patients and “control” patients were selected based on TNM staging parameters. Case patients (n = 64) had T1 NSCLCs that were N3 or M1 or both, while “control” patients (n = 206) had T2 or T3, N0 to N2, and M0 NSCLCs. Univariate and multivariable logistic regression were used to identify factors associated with SA-NSCLC.ResultsIn bootstrap bias–corrected multivariable logistic regression models, small aggressive adenocarcinomas were associated with a positive history of emphysema (odds ratio [OR] = 5.15, 95% confidence interval [CI] = 1.63 to 23.00) and the interaction of female sex and a positive family history of lung cancer (OR = 6.55, 95% CI = 1.06 to 50.80).ConclusionsEmphysema may play a role in early lung cancer progression. Females with a family history of lung cancer are at increased risk of having small aggressive lung adenocarcinomas. These results validate previous findings and encourage research on the role of female hormones interacting with family history and genetic factors in lung carcinogenesis and progression.

【 授权许可】

CC BY-NC-ND