Epidemiology and Survival of Malignant Central Airway Obstruction in Lung Cancer Identified on Cross-Sectional Imaging

• Published in: Journal of bronchology & interventional pulmonology Vol. 31; no. 3
• Main Authors: Ivanick, Nathaniel M, Kunadharaju, Rajesh, Bhura, Sajeer, Mengiste, Hiwot, Saeed, Musa, Saradna, Arjun, Grover, Harshwant, Kalvapudi, Sukumar, Yendamuri, Sai, Yu, Han, Shafirstein, Gal, Reid, Mary
• Format: Journal Article
• Language: English
• Published: United States 01-07-2024
• Subjects: Aged; Aged, 80 and over; Airway Obstruction - diagnostic imaging; Airway Obstruction - epidemiology; Airway Obstruction - mortality; Carcinoma, Squamous Cell - complications; Carcinoma, Squamous Cell - diagnostic imaging; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - mortality; Female; Humans; Incidence; Lung Neoplasms - complications; Lung Neoplasms - epidemiology; Lung Neoplasms - mortality; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Prevalence; Retrospective Studies; Small Cell Lung Carcinoma - complications; Small Cell Lung Carcinoma - diagnostic imaging; Small Cell Lung Carcinoma - epidemiology; Small Cell Lung Carcinoma - mortality; Tomography, X-Ray Computed
• ISSN: 1948-8270; 1948-8270
• DOI: 10.1097/LBR.0000000000000970

The prevalence of malignant central airway obstruction at diagnosis and its 5-year incidence are largely unknown, as are basic epidemiological data pertaining to this serious condition. To address these data limitations, we retrospectively collected data from the cohort of patients diagnosed with lung cancer at our institution in 2015 and followed cohort patients 5 years forward, until 2020.
We reviewed index PET/CT or CT scans at the time of lung cancer diagnosis to identify the presence, subtype, and severity of malignant central airway obstruction as well as progression/development over the next 5 years.
The prevalence of malignant central airway obstruction affecting the airway lumen by 25% or greater was 17%, and its 5-year incidence of development was 8.2%. Notable associations from the multivariate analysis included a younger age and a stepwise increase in obstruction with increasing stage of disease. Squamous cell carcinoma and small-cell lung cancer were the 2 histologic subtypes with the strongest association with obstruction. The presence of malignant central airway obstruction either at time of diagnosis or on follow-up imaging was associated with significantly shortened survival (multivariate Cox proportional HR for MCAO=1.702, P<0.001).
This study provides the first systematic characterization of fundamental epidemiological data on malignant central airway obstructions at a tertiary cancer center in the United States. This data is important to inform research directions and funding efforts of this serious complication. It also serves as a baseline value against which to compare for future studies.