Multicentric Italian early Lung
cancer Detection project
Functional evaluation and
Risk in COPD Patients
Elisa Calabrò
U.O. di Chirurgia Toracica – INT Milano
Clinica Pneumologica Università di Parma
Istituto Nazionale Tumori 24 Marzo, Milano
Introduction
Relationship between lung
obstruction is well recognized
cancer
and
airflow
COPD and lung cancer are caused primarily by smoking
Patients who stopped smoking had a slight improvement
in FEV1 followed by a mild decline. Those who continued
smoking had a much more rapid decline, indicating a
poor prognosis in years to come
Smoke and decline of respiratory function
Non smokers
Smokers
Plateau
FEV1
Peak
Decline
birth
20
age (year)
40
COPD results from an interaction between
host and environmental factors
Host factors




genetic susceptibility
AAT deficiency
other possible genetic factors
phenotypic susceptibility
Environmental exposures



tobacco smoke (active and passive)
occupational dusts and chemicals
air pollution (indoor and outdoor)
Genetic (host) risk factors in COPD

Genetic susceptibility influences occurrence of
COPD

Not every active smokers get clinical COPD

But Smoking is responsible for 90% of cancer
deaths
Because smoking and airflow obstruction
are such powerful risk factors for lung
cancer, their assessment is useful in
patient evaluation. Risk can be stratified
on the basis of the age (49-75), of the
presence or absence of smoking (20
packs/year) and the presence or absence
of symptoms. Patients at highest risk are
those who smoke heavily, have
spirometric abnormalities, and
have
symptoms.
Deficit restrittivo: riduzione
della CV ( o della CVF), e
proporzionalmente, di tutti i
volumi e di tutte le capacità
polmonari;
il
rapporto
VEMS/CVF pertanto rimane
normale.
Deficit ostruttivo: riduzione del
VEMS e dei flussi espiratori,
con diminuzione anche del
rapporto
VEMS/CVF.
Classification of Severity of COPD
Global Initiative for Chronic
Obstructive
Lung
Disease
STAGE
0 AT RISK
Normal Spirometry
I MILD
FEV1/FVC <70% and FEV1 80% predicted
II MODERATE
FEV1/FVC <70% and FEV1 50–80% predicted
III SEVERE
FEV1/FVC <70% and FEV1 30–50% predicted
IV VERY SEVERE FEV1/FVC <70% and FEV1 <30% predicted
Guidelines to estimate the risk in resective
pulmonary procedure
Parameters
Increased risk
High risk
Spirometry
FVC
FEV1
MVV
< 50% of pred
< 2 liter o 60% of pred
< 1.5 liter
< 1 liter
< 50% of pred
Diffusion capacity
DLCO
< 60% of pred
Blood gas PaCO2
> 45 mmHg
R. E. Hyatt et al, 1997
Post-operating risk based on the maximum
oxygen consumption (VO2max)
Morbidity 75-100%
VO2max < 15 ml/Kg/min
Mortality 15-75%
Post-operative Morbidity < 10%
VO2max > 20 ml/Kg/min
Post-operative Mortality
0
“One stop shop”
Quantitative CT:
predict post op
lung function
Reliability of quantitative computed tomography to predict
postoperative lung function in patients with chronic obstructive
pulmonary disease having a lobectomy
Virtual upper right lobectomy
On the quantitative CT
map, the white areas
denote the “functional
lung parenchyma.” By
applying the range of
density from -910 to -1024
HU, the white areas of
emphysema were clearly
depicted.
J Comput Assist Tomogr. 2005 Nov-Dec;29(6):819-24.
AIMS

Correlation between COPD and lung cancer
 Correlation between

Correlation between
GOLD stage and surgery
risk

Correlation between
GOLD stage and postoperative mortality

Correlation between
COPD and post-operative
complication
GOLD stage and longterm survival
 Correlation between
GOLD stage and
pathological stage
 Correlation between
COPD and histological
subtype