Herein, we report an autopsy case of idiopathic pulmonary fibrosis (IPF) in which remarkable honeycomb cyst expansion appeared in the clinical course. Radiological findings initially showed subpleural predominant reticulation that had progressed to usual interstitial pneumonia with honeycomb cysts, along with a restrictive pattern in the pulmonary function tests. The diameter of honeycomb cysts had gradually increased, and some cysts had abruptly expanded at the end stage. Based on pathological findings of autopsy specimens, bronchiectasis, alveolar collapse due to inflammation, and check-valve mechanism caused by a slit-like orifice of the cysts could have contributed to honeycomb cyst expansion.
Background
The association of treatment-induced tumor shrinkage with symptom palliation for patients with lung cancer remains unknown. We investigated this correlation using the Edmonton Symptom Assessment System–Revised.
Methods
Using the in-hospital cancer registry, we identified patients receiving chemotherapy and/or immunotherapy for newly diagnosed advanced or metastatic lung cancer. Tumor response and post-treatment Edmonton Symptom Assessment System–Revised were obtained after 2–3 treatment cycles. Patients were divided into groups with or without >30% unidirectional tumor shrinkage (objective response [OR] or non-OR [N-OR] groups, respectively). They were further classified as good-objective response (>50% unidirectional tumor shrinkage), moderate-objective response (30–50% shrinkage), progressive disease (>20% tumor growth or new lesion) or stable disease (SD; N-objective response and non-progressive disease). The primary endpoint was change in the total Edmonton Symptom Assessment System–Revised score from baseline. The Mann–Whitney U test was used for analysis.
Results
In total, 113 patients were enrolled. The total Edmonton Symptom Assessment System–Revised score was significantly more improved in the OR group versus the N-OR group (median: 5 vs. 2, respectively; P = 0.013). This association was more prominent in patients with small-cell lung cancer and large-cell neuroendocrine tumor than those with other histology. Sensitivity analyses showed that the total Edmonton Symptom Assessment System–Revised score was more improved in the OR group versus the SD group (median: 5 vs. 3, respectively; P = 0.029) and in the ‘good-OR’ group versus the ‘moderate-OR and SD’ group (median: 7.5 vs. 2, respectively; P = 0.003), suggesting that greater tumor shrinkage led to more symptom amelioration.
Conclusions
Tumor shrinkage was associated with Edmonton Symptom Assessment System–Revised score improvement in patients with lung cancer receiving systemic therapy.
Skeletal muscle atrophy often complicates idiopathic pulmonary fibrosis (IPF). IPF patients frequently experience acute exacerbation (AE), but the association between skeletal muscle atrophy and mortality remains unknown in AE-IPF patients. Herein, cross-sectional areas of the erector spinae muscle (ESMCSA) and the pectoralis muscle (PMCSA) of AE-IPF patients were analysed via computed tomography. Primary outcome was 90-day mortality. Survival probability was estimated using the Kaplan–Meier method, and the log-rank test was used between the low and high groups of ESMCSA and PMCSA. We used multivariable Cox proportional-hazards models to evaluate the association between ESMCSA and PMCSA and prognosis. Among the 212 patients, 94 (44%) died during the observation period. The low ESMCSA group (< 25.6 cm2) had a significantly worse prognosis than the high group (≥ 25.6 cm2) (hazard ratio (HR) [95% confidence interval (CI)]: 1.52 [1.00–2.33], p = 0.049). Multivariable analyses showed that all-cause mortality was associated with low ESMCSA (model 1, adjusted HR [95% CI]: 1.59 [0.98–2.60]; model 2, 1.55 [0.95–2.56] and model 3, 1.67 [1.00–2.78]). A similar trend was observed between low PMCSA and poor prognosis (HR [95% CI]: 1.39 [0.88–2.20]). In conclusion, low ESMCSA is associated with high 90-day mortality in AE-IPF patients.
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