Low diffusing capacity, emphysema, or pulmonary fibrosis: who is truly pulling the lung cancer strings?

Ozeki et al. reported that patients with low carbon monoxide diffusing capacity of the lung (DLCO) values had lung adenocarcinoma with aggressive histopathological features (1). This correlation remained significant despite adjustment for potentially confounding variables such as age, smoking status, tumor size, and forced expiratory volume at 1 s. Thus, the observation suggests a theoretical concept that increased damage to the underlying lung can promote the carcinogenesis of aggressive lung cancer.