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Managing High-Risk Lung Cancer

Managing High-Risk Lung Cancer

Studies have shown that surgery provides the best outcome for patients with early-stage lung cancer. However, up to 20% of these patients are classified as high risk or inoperable, and thus undergo non-operative treatments. Factors traditionally linked to high risk for pulmonary resection include age older than 75, tobacco abuse, or extensive medical comorbidities. “Many high-risk patients with early-stage lung cancer are deemed inoperable based on current criteria,” says Manu S. Sancheti, MD. “However, a consensus on the definition of risk currently does not exist and these patients may be consequently denied surgery.”   Comparing Outcomes Dr. Sancheti and colleagues have published a study in Annals of Thoracic Surgery that compared outcomes of patients who underwent lung cancer surgery considered to be high risk with those of standard risk. The investigation involved 490 patients with clinical stage I lung cancer who underwent pulmonary resection at Emory University between 2009 and 2013. Major criteria for high risk included a forced expiratory volume in one second (FEV1) or diffusion capacity of carbon dioxide (DLCO) of less than 50%. Minor factors included two of the following: age older than 75, or a FEV1 or DLCO of 51% to 60%. In the cohort, 180 were classified as high-risk. These patients were older than standard-risk patients (70 vs 65 years) and had worse FEV1 and DLCO levels. High-risk patients also had more smoking pack-years, a greater incidence of COPD, and were more likely to undergo sublobar resection. The length of stay was longer for the high-risk group with a slight increase in perioperative complications. “However, we did not observe a statistically significant difference in...
Previous Respiratory Disease & Lung Cancer

Previous Respiratory Disease & Lung Cancer

Studies have suggested a relationship between previous respiratory diseases and a lung cancer diagnosis. Most of this research has been conducted in Asian populations and does not account for the high level of co-occurrence that has been observed among different respiratory diseases. To better understand the relationship between multiple previous respiratory diseases and lung cancer risk, Paolo Boffetta, MD, MPH, and colleagues pooled data from a consortium of seven case-control studies as part of the SYNERGY project, which provided detailed information on smoking habits in European and North American populations. New Findings Data on five previous respiratory diseases—chronic bronchitis, emphysema, tuberculosis, pneumonia, and asthma—were collected by self-report for the study, which was published in the American Journal of Respiratory and Critical Care Medicine. Analyses were stratified by gender and adjusted for study center, age, employment in an occupation with an excess risk of lung cancer, level of education, smoking status, cigarette pack-years, and time since quitting smoking. According to the results, patients with chronic bronchitis, emphysema, and pneumonia were at higher risk of lung cancer when compared with those who had no previous respiratory disease diagnoses. In men, chronic bronchitis and emphysema were associated with odds ratios (ORs) of 1.33 and 1.50, respectively, for lung cancer. Men who were diagnosed with pneumonia 2 or fewer years prior to lung cancer were also at greater risk of lung cancer (OR, 3.31), but this correlation leveled off when a pneumonia diagnosis was made after the 2-year threshold. Patients with co-occurring chronic bronchitis, emphysema, and pneumonia had a higher risk of lung cancer than those who had any of these conditions alone....
CT-Based Lung Cancer Screening in HIV

CT-Based Lung Cancer Screening in HIV

Studies have found that patients with HIV have a two- to five-fold greater risk of lung cancer when compared with patients from the general population. Other research has suggested that CT-based lung cancer screening can help decrease lung cancer mortality in heavy smokers. Pairing these findings together has led to speculation that patients with HIV, particularly those who smoke, may be a key target for CT-based lung cancer screening. However, approximately 20% of chest CT scans show abnormalities suggestive of lung cancer. This could lead to invasive tests with downstream complications. “Because patients with HIV are more likely than the general population to have a history of lung infections or other pulmonary diseases,” explains Keith Sigel, MD, MPH, “they may have more abnormalities on their CT scans. This can increase their risk of false-positive findings on CT-based lung cancer screening.” New Findings For a study published in AIDS, Dr. Sigel and colleagues analyzed data on patients with and without HIV who were at risk of lung disease. The study aimed to determine whether or not HIV had an effect on the development of lung disease by comparing the frequency of incidental findings—particularly pulmonary nodules—observed on chest CT scans. “We looked at the number of patients who had positive screens in each group and followed those patients to determine the end result of those findings on the CT scans,” says Dr. Sigel. Dr. Sigel and colleagues found that, overall, HIV-infected patients did not have significantly more positive scans (29%) than HIV-uninfected patients (24%). However, HIV-infected patients with CD4 counts lower than 200 had significantly higher odds of positive CT scans...
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