Prognosis of non-small-cell lung cancer in patients with idiopathic pulmonary fibrosis

Song Yi Han, Youlim Kim, Yeon Joo Lee, Jong Sun Park, Young-Jae Cho, Ho Il Yoon, Jae-Ho Lee, Choon-Taek Lee, Jin-Haeng Chung, Kyung Won Lee, Sang Hoon Lee
2018 Lung Cancer   unpublished
The risk of lung cancer is higher in idiopathic pulmonary fibrosis (IPF) because both conditions share common risk factors. However, no standard treatment modality for LC in IPF exists due to rare incidence, poor prognosis, and acute exacerbation (AE) of IPF during treatment. We aimed to determine the efficacy of LC treatments and the prognosis in LC patients with IPF according to the LC stage and GAP (gender [G], age [A], and two physiology variables [P]) stage. From 2003 to 2016, 160
more » ... 2016, 160 retrospectively enrolled patients were classified according to the LC clinical stage and GAP stage. The average (±standard deviation) patient age was 70.1 ± 8.2 years; the cohort predominantly comprised men (94.4%). In GAP stage I, surgery was significantly associated with better survival outcomes in LC. In contrast, no treatment modality yielded significant clinical improvement in GAP stage II/III. The incidences of AE in IPF and its mortality during treatment were 13.8% and 6.3%, respectively. AE occurred commonly in advanced GAP stage. Active treatment should be considered in GAP stage I. The performance status and LC stage should be considered when deciding about the necessity of surgery for patients in advanced GAP stage. Idiopathic pulmonary fibrosis (IPF) is the most frequent and severe type of idiopathic interstitial pneumonia (IIP) with an unknown aetiology. IPF has a median survival of approximately 2 to 3 years after diagnosis and presents with a histologic pattern of usual interstitial pneumonia (UIP) on computed tomography (CT) 1 . Disease progression is characterised by ongoing fibrosis, worsening dyspnoea, and decreasing pulmonary function tests (PFT), particularly forced vital capacity (FVC) and diffusing capacity for carbon monoxide (DL CO ) 2,3 . Emerging evidence shows that IPF is an important risk factor for lung cancer (LC) development 4 . Moreover, the prevalence of LC increases from the time of IPF diagnosis 5,6 . Ozawa et al. reported that the cumulative prevalence of LC is increased to 3.3%, 15.4%, and 54.7% after 1, 5, and 10 years from IPF diagnosis 7 . Previous studies showed that the prevalence of LC and IPF (LC-IPF) is higher in older men, those who smoke, and those with squamous cell carcinoma 8, 9 . Although the exact relationship between LC and IPF has not yet been established, epigenetic changes, genetic changes, and oxidative stress are thought to be involved in the development of LC-IPF 10 . In the treatment of patients with LC-IPF, physicians are reluctant to treat LC because of the poor prognosis of IPF 11 . In addition, complications such as pneumonia, acute exacerbation of IPF (AE-IPF), acute respiratory distress syndrome, and air leakage after lung surgery are relatively more frequent in LC-IPF patients than in those with LC alone, thus resulting in higher mortality rates 12,13 . These complications and high mortality makes the treatment of LC difficult. Although some studies suggest that surgical treatment is effective in IPF patients
doi:10.1183/13993003.congress-2018.pa2814 fatcat:tq5ws6bb7rfgdp5m4ikmj46yda