Similar radiopathological features, but different postoperative recurrence rates, between Stage I lung cancers arising in emphysematous lungs and those arising in nonemphysematous lungs.

OBJECTIVES The aim of the present study was to clarify the differences between lung cancer arising in emphysematous lungs and that arising in nonemphysematous lungs with regard to radiopathological features and the postoperative recurrence rate. METHODS We retrospectively reviewed a prospective database of 212 patients who underwent major lung resection for clinically diagnosed Stage I primary lung cancer. Emphysematous lungs were identified on the basis of quantitative computed tomography (CT). The biological features of the primary tumour were diagnosed according to the presence or absence of a ground-glass component on high-resolution CT and the maximum standardized uptake value in [(18)F]-fluorodeoxyglucose positron emission tomography, in addition to conventional characteristic factors. RESULTS The risk factors for postoperative recurrence were underlying emphysema, a high maximum standardized uptake value, the absence of a ground-glass component, the pathological grade and lymph node metastasis, whereas the risk factors for lymph node metastasis were a high maximum standardized uptake value, the absence of a ground-glass component and the pathological grade. Surprisingly, these risk factors were entirely matched between patients with and without emphysematous lungs, regardless of the fact that patients with emphysematous lungs had a higher recurrence rate. CONCLUSIONS Similar clinicopathological features, but different postoperative recurrence rates, were found between Stage I lung cancers arising in emphysematous lungs and those arising in nonemphysematous lungs. It may be valuable to search for underlying molecular mechanisms that promote metastasis from primary tumours arising in emphysema, such as paracrine effects between the tumour and pulmonary emphysema.