Multicentric Italian early Lung cancer Detection project Functional evaluation and

1. 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

2. Introduction Relationship between lung cancer and airflow obstruction is well recognized 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

3. Smoke and decline of respiratory function Non smokers Smokers Plateau Peak FEV1 Decline 20 birth 40 age (year)

4. 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)

5. 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

6. 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.

7. 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.

8. Classification of Severity of COPD Global Initiative for Chronic Obstructive Lung Disease STAGE

13. Guidelines to estimate the risk in resective pulmonary procedure R. E. Hyatt et al, 1997

14. 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

15. “One stop shop” Quantitative CT: predict post op lung function

16. Reliability of quantitative computed tomography to predict postoperative lung function in patients with chronic obstructive pulmonary disease having a 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. Virtual upper right lobectomy J Comput Assist Tomogr. 2005 Nov-Dec;29(6):819-24.

17. Correlation between GOLD stage and long-term survival Correlation between GOLD stage and pathological stage Correlation between COPD and histological subtype Correlation between GOLD stage and surgery risk Correlation between GOLD stage and post-operative mortality Correlation between COPD and post-operative complication AIMS • Correlation between COPD and lung cancer