Idiopathic Pulmonary Fibrosis and Lung Cancer. A Systematic Review and Meta-analysis

Abstract

Rationale:The association between idiopathic pulmonary fibrosis (IPF) and lung cancer has been previously reported. However, there is the potential for significant confounding by age and smoking, and an accurate summary risk estimate has not been previously ascertained.Objectives: To determine the risk and burden of lung cancer in patients with IPF, accounting for known confounders.Methods: We conducted a comprehensive literature search of MEDLINE, EMBASE, and SCOPUS databases and used the Newcastle Ottawa criteria to assess study quality. We then assessed the quality of ascertainment of IPF cases based on modern consensus criteria. Data that relied on administrative claims or autopsies were excluded. We calculated summary risk estimates using a random effects model.Results: Twenty-five cohort studies were included in the final analysis. The estimated adjusted incidence rate ratio from two studies was 6.42 (95% confidence interval [CI], 3.21-9.62) and accounted for age, sex, and smoking. The summary incidence rate from 11 studies was 2.07 per 100 person-years (95% CI, 1.46-2.67), and the summary mortality rate was 1.06 per 100 person-years (95% CI, 0.62-1.51) obtained from three studies. The summary prevalence from 11 studies was 13.74% (95% CI, 10.17-17.30), and the proportion of deaths attributable to lung cancer was 10.20 (95% CI, 8.52-11.87) and was obtained from nine studies.Conclusions: IPF is an increased independent risk factor for lung cancer, even after accounting for smoking. Further well-designed studies using modern consensus criteria are needed to explore mechanisms of this association.

Risk factors and clinical characteristics of lung cancer in idiopathic pulmonary fibrosis: a retrospective cohort study

“…Finally, in a recent systematic review, the estimated adjusted incidence rate ratio from 2 large cohort studies was reported to be 6.42 after adjustment for age, smoking, and gender. [22] The high incidence density rate of 32.6/1000 person-years and 10-year cumulative incidence of 31.1% in our study is in line with previous studies that IPF is frequently associated with lung cancer. Of note, the difference in our study lies in exclusion of patients who were diagnosed with IPF and lung cancer simultaneously and the relatively large number of patients.…”

Immune Checkpoint Inhibitor-Related Pneumonitis

“…In fact, different pathogenic mechanisms are involved in the most common ILDs, namely connective tissue disease-associated ILD, hypersensitivity pneumonitis (HP), and idiopathic pulmonary fibrosis [48]. The latter not only is not associated with autoimmune mechanisms, but it also shares a plethora of pathogenic mechanisms with lung cancer [49, 50] ILD is frequently associated with lung cancer [51-54], and the coexisting of the 2 complicates the management of those patients [55]. Recently, a prospective, single-arm, phase II trial was conducted in patients with NSCLC and mild ILD, which showed that nivolumab is efficacious in that group of patients.…”

A Primer on Interstitial Lung Disease and Thoracic Radiation

“…1 In a systematic review analyzing the association between IPF and lung cancer, the estimated incidence rate ratio was 6.42 when adjusted for age, sex, and smoking, and IPF was found to be an independent risk factor for lung cancer even after accounting for smoking status. 3 Figure 4. Comparison of a high-resolution computed tomography (HRCT) versus a standard computed tomography image taken on the same day in a 75-year-old male patient with idiopathic pulmonary fibrosis.…”

“…Patients with ILD are at a higher risk of developing lung cancer, and have worse outcomes than patients without ILD who develop lung cancer. [1][2][3][4] Emerging evidence suggests that patients with ILD undergoing any treatment, including thoracic radiotherapy (TRT), are at a higher risk of treatmentrelated toxicities, compounding their baseline risk of morbidity from life-threatening ILD exacerbations. [5][6][7][8][9] Thus, patients with concomitant diagnoses of ILD and lung cancer represent a unique challenge in oncologic management.…”