Analysis on the Clinical Characteristics and Survival of 53 Patients with Pulmonary Fibrosis Complicated with Lung Cancer_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

CaoMengshu ¹ , WangXin ² , GuPeiyu ² , CaoMin ¹ , HuangMei ¹ , MengFanqing ³ , ZhuBin ⁴ , XiaoYonglong ¹ ,  CaiHourong ¹

1. Department of Respiratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, 210008, China;
2. ;
3. ;
4. ;

Corresponding author：

CaiHourong, Email: caihourong2013@163.com

Keywords：

Pulmonary fibrosis; Lung cancer; Survival; Clinical variables

DOI：

10.7507/1671-6205.2016052

Video：

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Objective To analyze the clinical characteristics and survival of pulmonary fibrosis (PF) patients complicated with lung cancer (LC) (PL-LC). Methods Fifty-three patients with PF diagnosed as LC from January 2008 to March 2014 in Nanjing Drum Tower Hospital were included in this study. Univariate analysis and Cox regression analysis were used to detect the effects of clinical variables on survival. Kaplan-Meier method was used to calculate the median survival time (MST) and overall survival (OS). Results Male patients (n=48, 90.6%) and patients with a history of smoking (n=42, 79.2%) were more easily suffered from PF-LC. The average age was 68.6±9.5 years. Cox multivariate analysis revealed that Velcro crackles (P=0.009) and clinical stage (P=0.013) were the independent risk factors of survival in the patients with PF-LC. The MST of 53 patients was 6.0 months.The survival rates of 1-year and 2-year were 34.1% and 22.0%, respectively. Forty-two (79.2%) patients were idiopathic pulmonary fibrosis (IPF) complicated with LC, and 11 (20.8%) patients were secondary pulmonary fibrosis (SPF) complicated with LC. OS difference between two groups was not significant (P=0.610). OS of NSCLC group (n=37) was significantly prolonged than that of SCLC group (n=6) and unclassified pathological pattern group (n=10) (P=0.035). OS of Ⅰ and Ⅱstage patients (n=13) was significantly longer than that of Ⅲ and Ⅳ stage patients (n=40) (P=0.002). MST and OS of patients with LC treated (n=31) were significantly better than those of untreated patients (n=22) (P < 0.001) and OS of patients treated by comprehensive therapy (n=11) was significantly prolonged than that of patients treated by mono-therapy (n=20) (P=0.036). Conclusions Velcro crackles and clinical stages are the independent risk factors of prognosis in PF-LC patients. It is beneficial to survival if the PF patients with LC were treated by comprehensive therapy.

Citation： Cao Mengshu, Wang Xin, Gu Peiyu, Cao Min, Huang Mei, Meng Fanqing, Zhu Bin, Xiao Yonglong, Cai Hourong. Analysis on the Clinical Characteristics and Survival of 53 Patients with Pulmonary Fibrosis Complicated with Lung Cancer. Chinese Journal of Respiratory and Critical Care Medicine, 2016, 15(3): 216-221. doi: 10.7507/1671-6205.2016052 Copy

1.	Bouros D, Hatzakis K, Labrakis H, et al. Association of malignancy with diseases causing interstitial pulmonary changes. Chest, 2002, 121:1278-1289.
2.	Watanabe N, Taniguchi H, Kondoh Y, et al. Efficacy of chemotherapy for advanced non-small cell lung cancer with idiopathic pulmonary fibrosis. Respiration, 2013, 85:326-331.
3.	Wells C, Mannino DM. Pulmonary fibrosis and lung cancer in the United States: analysis of the multiple cause of death mortality data, 1979 through 1991. South Med J, 1996, 89:505-510.
4.	Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med, 2011, 183:788-824.
5.	蔡后荣.对特发性肺纤维化诊断和治疗循证指南的几点刍议.中华结核和呼吸杂志, 2012, 35:156-157.
6.	蔡后荣.特发性肺纤维化临床研究中亟待关注的问题.中华结核和呼吸杂志, 2010, 33:881-883.
7.	Bohan A, Peter JB. Polymyositis and dermatomyositis. New Engl J Med, 1975, 292(7-8):344-347, 403-407.
8.	Shiboski SC, Shiboski CH, Criswell L, et al. American College of Rheumatology classification criteria for Sj gren's syndrome: a data-driven, expert consensus approach in the Sj gren's International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken), 2012, 64:475-487.
9.	Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum, 2010, 62:2569-2581.
10.	Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum, 2013, 65:1-11.
11.	Mosca M, Tani C, Bombardieri S. Undifferentiated connective tissue diseases (UCTD): a new frontier for rheumatology. Best Pract Res Clin Rheumatol, 2007, 21:1011-1023.
12.	van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum, 2013, 65:2737-2747.
13.	Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2:706-714.
14.	Archontogeorgis K, Steiropoulos P, Tzouvelekis A, et al. Lung cancer and interstitial lung diseases: a systematic review. Pulm Med, 2012, 2012:315918.
15.	Song DH, Choi IH, Ha SY, et al. Usual interstitial pneumonia with lung cancer: clinicopathological analysis of 43 cases. Korean J Pathol, 2014, 48:10-16.
16.	Turner-Warwick M, Lebowitz M, Burrows B, et al. Cryptogenic fibrosing alveolitis and lung cancer. Thorax, 1980, 35:496-499.
17.	Drakopanagiotakis F, Xifteri A, Polychronopoulos V, et al. Apoptosis in lung injury and fibrosis. Eur Respir J, 2008, 32:1631-1638.
18.	Hill CL, Nguyen AM, Roder D, et al. Risk of cancer in patients with scleroderma: a population based cohort study. Ann Rheum Dis, 2003, 62:728-731.
19.	Gabrilovich M, Raza M, Dolan S, et al. Paraneoplastic polymyositis associated with squamous cell carcinoma of the lung. Chest, 2006, 129:1721-1723.
20.	Voltolini L, Bongiolatti S, Luzzi L, et al. Impact of interstitial lung disease on short-term and long-term survival of patients undergoing surgery for non-small-cell lung cancer: analysis of risk factors. Eur J Cardiothorac Surg, 2013, 43:e17-23.
21.	Saito Y, Kawai Y, Takahashi N, et al. Survival after surgery for pathologic stage ⅠA non-small cell lung cancer associated with idiopathic pulmonary fibrosis. Ann Thorac Surg, 2011, 92:1812-1817.
22.	Watanabe A, Miyajima M, Mishina T, et al. Surgical treatment for primary lung cancer combined with idiopathic pulmonary fibrosis. Gen Thorac Cardiovasc Surg, 2013, 61:254-261.
23.	Parambil JG, Myers JL, Ryu JH. Histopathologic features and outcome of patients with outcome of patients with exacerbation of idiopathic pulmonary fibrosis undergoing surgical lung biopsy. Chest, 2005, 128:3310-3315.
24.	张德平.特发性肺纤维化合并肺癌.中华结核和呼吸杂志, 2012, 35:647-649.
25.	Watanabe N, Taniguchi H, Kondoh Y, et al. Chemotherapy for extensive-stage small-cell lung cancer with idiopathic pulmonary fibrosis. Int J Clin Oncol, 2014, 19:260-265.

1. Bouros D, Hatzakis K, Labrakis H, et al. Association of malignancy with diseases causing interstitial pulmonary changes. Chest, 2002, 121:1278-1289.
2. Watanabe N, Taniguchi H, Kondoh Y, et al. Efficacy of chemotherapy for advanced non-small cell lung cancer with idiopathic pulmonary fibrosis. Respiration, 2013, 85:326-331.
3. Wells C, Mannino DM. Pulmonary fibrosis and lung cancer in the United States: analysis of the multiple cause of death mortality data, 1979 through 1991. South Med J, 1996, 89:505-510.
4. Raghu G, Collard HR, Egan JJ, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med, 2011, 183:788-824.
5. 蔡后荣.对特发性肺纤维化诊断和治疗循证指南的几点刍议.中华结核和呼吸杂志, 2012, 35:156-157.
6. 蔡后荣.特发性肺纤维化临床研究中亟待关注的问题.中华结核和呼吸杂志, 2010, 33:881-883.
7. Bohan A, Peter JB. Polymyositis and dermatomyositis. New Engl J Med, 1975, 292(7-8):344-347, 403-407.
8. Shiboski SC, Shiboski CH, Criswell L, et al. American College of Rheumatology classification criteria for Sj gren's syndrome: a data-driven, expert consensus approach in the Sj gren's International Collaborative Clinical Alliance cohort. Arthritis Care Res (Hoboken), 2012, 64:475-487.
9. Aletaha D, Neogi T, Silman AJ, et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum, 2010, 62:2569-2581.
10. Jennette JC, Falk RJ, Bacon PA, et al. 2012 revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. Arthritis Rheum, 2013, 65:1-11.
11. Mosca M, Tani C, Bombardieri S. Undifferentiated connective tissue diseases (UCTD): a new frontier for rheumatology. Best Pract Res Clin Rheumatol, 2007, 21:1011-1023.
12. van den Hoogen F, Khanna D, Fransen J, et al. 2013 classification criteria for systemic sclerosis: an American College of Rheumatology/European League against Rheumatism collaborative initiative. Arthritis Rheum, 2013, 65:2737-2747.
13. Goldstraw P, Crowley J, Chansky K, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours. J Thorac Oncol, 2007, 2:706-714.
14. Archontogeorgis K, Steiropoulos P, Tzouvelekis A, et al. Lung cancer and interstitial lung diseases: a systematic review. Pulm Med, 2012, 2012:315918.
15. Song DH, Choi IH, Ha SY, et al. Usual interstitial pneumonia with lung cancer: clinicopathological analysis of 43 cases. Korean J Pathol, 2014, 48:10-16.
16. Turner-Warwick M, Lebowitz M, Burrows B, et al. Cryptogenic fibrosing alveolitis and lung cancer. Thorax, 1980, 35:496-499.
17. Drakopanagiotakis F, Xifteri A, Polychronopoulos V, et al. Apoptosis in lung injury and fibrosis. Eur Respir J, 2008, 32:1631-1638.
18. Hill CL, Nguyen AM, Roder D, et al. Risk of cancer in patients with scleroderma: a population based cohort study. Ann Rheum Dis, 2003, 62:728-731.
19. Gabrilovich M, Raza M, Dolan S, et al. Paraneoplastic polymyositis associated with squamous cell carcinoma of the lung. Chest, 2006, 129:1721-1723.
20. Voltolini L, Bongiolatti S, Luzzi L, et al. Impact of interstitial lung disease on short-term and long-term survival of patients undergoing surgery for non-small-cell lung cancer: analysis of risk factors. Eur J Cardiothorac Surg, 2013, 43:e17-23.
21. Saito Y, Kawai Y, Takahashi N, et al. Survival after surgery for pathologic stage ⅠA non-small cell lung cancer associated with idiopathic pulmonary fibrosis. Ann Thorac Surg, 2011, 92:1812-1817.
22. Watanabe A, Miyajima M, Mishina T, et al. Surgical treatment for primary lung cancer combined with idiopathic pulmonary fibrosis. Gen Thorac Cardiovasc Surg, 2013, 61:254-261.
23. Parambil JG, Myers JL, Ryu JH. Histopathologic features and outcome of patients with outcome of patients with exacerbation of idiopathic pulmonary fibrosis undergoing surgical lung biopsy. Chest, 2005, 128:3310-3315.
24. 张德平.特发性肺纤维化合并肺癌.中华结核和呼吸杂志, 2012, 35:647-649.
25. Watanabe N, Taniguchi H, Kondoh Y, et al. Chemotherapy for extensive-stage small-cell lung cancer with idiopathic pulmonary fibrosis. Int J Clin Oncol, 2014, 19:260-265.

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Analysis on the Clinical Characteristics and Survival of 53 Patients with Pulmonary Fibrosis Complicated with Lung Cancer

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