World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website https://www.wjon.org

Original Article

Volume 15, Number 2, April 2024, pages 246-256

Association of Lung Cancer Risk With the Presence of Both Lung Nodules and Emphysema in a Lung Cancer Screening Trial

Figure 1. Flow chart of participants’ selection. NENN group: non-emphysema and non-nodules; E group: emphysema without nodules; N group: nodules without emphysema; E + N group: nodules with emphysema.

Figure 2. Kaplan-Meier survival curves of lung cancer incidence (a), lung cancer mortality (b) and all-cause mortality (c). NENN group: non-emphysema and non-nodules; E group: emphysema without nodules; N group: nodules without emphysema; E + N group: nodules with emphysema.

Figure 3. Forest plot of associations of four groups participants with lung cancer incidence, lung cancer mortality and all-cause mortality. Model 1a: adjusted for age. Model 2b: adjusted for age, gender, race/ethnicity, education level, marital status, smoking status, smoking pack-year, BMI and family history of lung cancer. NENN group: non-emphysema and non-nodules; E group: emphysema without nodules; N group: nodules without emphysema; E + N group: nodules with emphysema; BMI: body mass index.

**Table 1.** Baseline Characteristics of the Study Group
Parameter	Overall (N = 21,949)	NENN group (n = 9,040)	E group (n = 5,819)	N group (n = 4,737)	E + N group (n = 2,353)	P value
P values from the χ² test. BMI: body mass index; NENN group: non-emphysema and non-nodules; E group: emphysema without nodules; N group: nodules without emphysema; E + N group: nodules with emphysema.
Age (years)						< 0.001
≤ 59	8,920 (40.6)	3,981 (44.0)	2,243 (38.5)	1,904 (40.2)	792 (33.7)
60 - 64	6,816 (31.1)	2,809 (31.1)	1,819 (31.3)	1,488 (31.4)	700 (29.7)
65 - 69	4,130 (18.8)	1,545 (17.1)	1,149 (19.7)	902 (19.0)	534 (22.7)
70 - 74	2,083 (9.5)	705 (7.8)	608 (10.4)	443 (9.4)	327 (13.9)
Sex						< 0.001
Women	8,996 (41.0)	3,764 (41.6)	2,269 (39.0)	2,079 (43.9)	884 (37.6)
Men	12,953 (59.0)	5,276 (58.4)	3,550 (61.0)	2,658 (56.1)	1,469 (62.4)
Race						< 0.001
White	20,099 (91.6)	8,167 (90.3)	5,319 (91.4)	4,407 (93.0)	2,206 (93.8)
Other	1,850 (8.4)	873 (9.7)	500 (8.6)	330 (7.0)	147 (6.2)
Education						< 0.001
< high school	1,416 (7.7)	557 (7.5)	397 (7.9)	279 (7.0)	183 (9.1)
Senior high school	8,336 (45.2)	3,230 (43.3)	2,290 (45.8)	1,859 (46.8)	957 (47.6)
College or above	8,691 (47.1)	3,672 (49.2)	2,311 (46.2)	1,836 (48.2)	872 (43.3)
Marital status						0.037
Married/living as married	14,741 (67.3)	6,028 (66.9)	3,879 (66.9)	3,226 (68.2)	1,608 (68.4)
Widowed/divorced/separated	6,153 (28.1)	2,525 (28.0)	1,677 (28.9)	1,301 (27.5)	650 (27.7)
Never married	995 (4.5)	457 (5.1)	242 (4.2)	204 (4.3)	92 (3.9)
BMI (kg/m²)						< 0.001
< 25	7,322 (33.5)	2,518 (28.0)	2,358 (40.6)	1,404 (29.7)	1,042 (33.5)
25 - 29.9	8,864 (40.5)	3,724 (41.4)	2,319 (39.9)	1,909 (40.4)	912 (38.9)
≥ 30	5,688 (26.0)	2,760 (30.7)	1,129 (19.4)	1,411 (29.9)	388 (16.6)
Smoking status						< 0.001
Former smoking	11,246 (51.2)	5,020 (55.5)	2,643 (45.4)	2,572 (54.3)	1,011 (43.0)
Current smoking	10,703 (48.8)	4,020 (44.5)	3,176 (54.6)	2,165 (45.7)	1,342 (57.0)
Smoking, pack-years						< 0.001
30 - 59	14,352 (65.4)	6,276 (69.4)	3,476 (59.7)	3,222 (68.0)	1,378 (58.6)
60 - 89	5,494 (25.0)	2,034 (22.5)	1,668 (28.7)	1,102 (23.3)	690 (29.3)
≥ 90	2,103 (9.6)	730 (8.1)	675 (11.6)	413 (8.7)	285 (12.1)
Family history of lung cancer						0.047
No	17,607 (80.2)	7,312 (80.9)	4,623 (79.4)	3,817 (80.6)	1,855 (78.8)
Yes	4,342 (19.8)	1,728 (19.1)	1,196 (20.6)	920 (19.4)	498 (21.2)

Table 1. Baseline Characteristics of the Study Group

Parameter

Overall (N = 21,949)

NENN group (n = 9,040)

E group (n = 5,819)

N group (n = 4,737)

E + N group (n = 2,353)

P value

P values from the χ² test. BMI: body mass index; NENN group: non-emphysema and non-nodules; E group: emphysema without nodules; N group: nodules without emphysema; E + N group: nodules with emphysema.

Age (years)

< 0.001

≤ 59

8,920 (40.6)

3,981 (44.0)

2,243 (38.5)

1,904 (40.2)

792 (33.7)

60 - 64

6,816 (31.1)

2,809 (31.1)

1,819 (31.3)

1,488 (31.4)

700 (29.7)

65 - 69

4,130 (18.8)

1,545 (17.1)

1,149 (19.7)

902 (19.0)

534 (22.7)

70 - 74

2,083 (9.5)

705 (7.8)

608 (10.4)

443 (9.4)

327 (13.9)

Sex

< 0.001

Women

8,996 (41.0)

3,764 (41.6)

2,269 (39.0)

2,079 (43.9)

884 (37.6)

Men

12,953 (59.0)

5,276 (58.4)

3,550 (61.0)

2,658 (56.1)

1,469 (62.4)

Race

< 0.001

White

20,099 (91.6)

8,167 (90.3)

5,319 (91.4)

4,407 (93.0)

2,206 (93.8)

Other

1,850 (8.4)

873 (9.7)

500 (8.6)

330 (7.0)

147 (6.2)

Education

< 0.001

< high school

1,416 (7.7)

557 (7.5)

397 (7.9)

279 (7.0)

183 (9.1)

Senior high school

8,336 (45.2)

3,230 (43.3)

2,290 (45.8)

1,859 (46.8)

957 (47.6)

College or above

8,691 (47.1)

3,672 (49.2)

2,311 (46.2)

1,836 (48.2)

872 (43.3)

Marital status

0.037

Married/living as married

14,741 (67.3)

6,028 (66.9)

3,879 (66.9)

3,226 (68.2)

1,608 (68.4)

Widowed/divorced/separated

6,153 (28.1)

2,525 (28.0)

1,677 (28.9)

1,301 (27.5)

650 (27.7)

Never married

995 (4.5)

457 (5.1)

242 (4.2)

204 (4.3)

92 (3.9)

BMI (kg/m²)

< 0.001

< 25

7,322 (33.5)

2,518 (28.0)

2,358 (40.6)

1,404 (29.7)

1,042 (33.5)

25 - 29.9

8,864 (40.5)

3,724 (41.4)

2,319 (39.9)

1,909 (40.4)

912 (38.9)

≥ 30

5,688 (26.0)

2,760 (30.7)

1,129 (19.4)

1,411 (29.9)

388 (16.6)

Smoking status

< 0.001

Former smoking

11,246 (51.2)

5,020 (55.5)

2,643 (45.4)

2,572 (54.3)

1,011 (43.0)

Current smoking

10,703 (48.8)

4,020 (44.5)

3,176 (54.6)

2,165 (45.7)

1,342 (57.0)

Smoking, pack-years

< 0.001

30 - 59

14,352 (65.4)

6,276 (69.4)

3,476 (59.7)

3,222 (68.0)

1,378 (58.6)

60 - 89

5,494 (25.0)

2,034 (22.5)

1,668 (28.7)

1,102 (23.3)

690 (29.3)

≥ 90

2,103 (9.6)

730 (8.1)

675 (11.6)

413 (8.7)

285 (12.1)

Family history of lung cancer

0.047

17,607 (80.2)

7,312 (80.9)

4,623 (79.4)

3,817 (80.6)

1,855 (78.8)

Yes

4,342 (19.8)

1,728 (19.1)

1,196 (20.6)

920 (19.4)

498 (21.2)

**Table 2.** Characteristics of Nodules, Overall and Stratified by With and Without Emphysema
Parameter	All nodules (N = 7,090)	N group (n = 4,737)	E + N group (n = 2,353)	P value
P values from the χ² test. N group: nodules without emphysema; E + N group: nodules with emphysema.
Size, mm				< 0.001
4 - 6	3,707 (52.4)	2,557 (54.1)	1,150 (49.0)
7 - 10	2,120 (30.0)	1,391 (29.4)	729 (31.1)
11 - 20	937 (13.3)	599 (12.7)	338 (14.4)
21 - 30	197 (2.8)	114 (2.4)	83 (3.5)
> 30	109 (1.5)	64 (1.4)	45 (1.9)
Localization				0.013
Right upper	1,733 (24.4)	1,137 (24.0)	596 (25.3)
Right middle	971 (13.7)	669 (14.1)	302 (12.8)
Right lower	1,681 (23.7)	1,145 (24.2)	536 (22.8)
Left upper	1,019 (14.4)	638 (13.5)	381 (16.2)
Lingula	304 (4.3)	218 (4.6)	86 (3.7)
Left lower	1,347 (19.0)	908 (19.2)	439 (18.7)
Other	35 (0.5)	22 (0.5)	13 (0.6)
Margins				< 0.001
Spiculated	865 (12.2)	462 (9.8)	403 (17.1)
Smooth	4,407 (62.2)	3,000 (63.3)	1,407 (59.8)
Poorly defined	1,467 (20.7)	983 (20.8)	484 (20.6)
Unable to determine	351 (5.0)	292 (6.2)	59 (2.5)
Component				0.004
Soft tissue	5,182 (73.1)	3,417 (72.1)	1,765 (75.1)
Ground glass	1,093 (15.4)	782 (16.5)	311 (13.2)
Mixed	389 (5.5)	259 (5.5)	130 (5.5)
Other	423 (6.0)	278 (5.9)	145 (6.2)

Table 2. Characteristics of Nodules, Overall and Stratified by With and Without Emphysema

Parameter

All nodules (N = 7,090)

N group (n = 4,737)

E + N group (n = 2,353)

P value

P values from the χ² test. N group: nodules without emphysema; E + N group: nodules with emphysema.

Size, mm

< 0.001

4 - 6

3,707 (52.4)

2,557 (54.1)

1,150 (49.0)

7 - 10

2,120 (30.0)

1,391 (29.4)

729 (31.1)

11 - 20

937 (13.3)

599 (12.7)

338 (14.4)

21 - 30

197 (2.8)

114 (2.4)

83 (3.5)

> 30

109 (1.5)

64 (1.4)

45 (1.9)

Localization

0.013

Right upper

1,733 (24.4)

1,137 (24.0)

596 (25.3)

Right middle

971 (13.7)

669 (14.1)

302 (12.8)

Right lower

1,681 (23.7)

1,145 (24.2)

536 (22.8)

Left upper

1,019 (14.4)

638 (13.5)

381 (16.2)

Lingula

304 (4.3)

218 (4.6)

86 (3.7)

Left lower

1,347 (19.0)

908 (19.2)

439 (18.7)

Other

35 (0.5)

22 (0.5)

13 (0.6)

Margins

< 0.001

Spiculated

865 (12.2)

462 (9.8)

403 (17.1)

Smooth

4,407 (62.2)

3,000 (63.3)

1,407 (59.8)

Poorly defined

1,467 (20.7)

983 (20.8)

484 (20.6)

Unable to determine

351 (5.0)

292 (6.2)

59 (2.5)

Component

0.004

Soft tissue

5,182 (73.1)

3,417 (72.1)

1,765 (75.1)

Ground glass

1,093 (15.4)

782 (16.5)

311 (13.2)

Mixed

389 (5.5)

259 (5.5)

130 (5.5)

Other

423 (6.0)

278 (5.9)

145 (6.2)