Radiological Characteristics, Histological Features and Clinical Outcomes of Lung Cancer Patients with Coexistent Idiopathic Pulmonary Fibrosis

Khan, Kashif Ali; Kennedy, Marcus P.; Moore, Elinoor; Crush, Lee; Prendeville, Susan; Maher, Michael M.; Burke, Louise M.; Henry, Michael T.

doi:10.1007/s00408-014-9664-8

Cited by 56 publications

(47 citation statements)

References 33 publications

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“…Furthermore, Khan et al. have reported a striking transition from metaplastic squamous epithelium (within the fibrotic areas) to invasive carcinoma in 50% of the resected squamous cell tumors from patients with IPF . Based on these findings, it is possible that lung cancer in patients with CPFE has a similar developmental process to that of lung cancer in patients with IPF, as these two groups exhibit increasing epithelial atypia, atypical metaplasia to carcinoma in situ, and invasive carcinoma in the surrounding fibrotic area.…”

Section: Discussionmentioning

confidence: 98%

The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema

et al. 2016

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Combined pulmonary fibrosis and emphysema (CPFE) is an important risk factor for lung cancer (LC), because most patients with CPFE are smokers. However, the histological characteristics of LC in patients with CPFE (LC‐CPFE) remain unclear. We conducted this study to explore the clinicopathological characteristics of LC‐CPFE. We retrospectively reviewed data from 985 patients who underwent resection for primary LC, and compared the clinicopathological characteristics of patients with LC‐CPFE and non‐CPFE LC. We identified 72 cases of LC‐CPFE, which were significantly associated with squamous cell carcinoma (SqCC) histology (n = 46, P < 0.001) and higher tumor grade (n = 44, P < 0.001), compared to non‐CPFE LC. Most LC‐CPFE lesions were contiguous with fibrotic areas around the tumor (n = 59, 81.9%), and this association was independent of tumor location. Furthermore, dysplastic epithelium was identified in the fibrotic area for 31 (52.5%) LC‐CPFE lesions. Moreover, compared to patients with pulmonary fibrosis alone in the non‐CPFE group (n = 31), patients with CPFE were predominantly male (P = 0.008) and smokers (P < 0.001), with LC‐CPFE predominantly exhibiting SqCC histology (P = 0.010) and being contiguous with the tumor‐associated fibrotic areas (P < 0.001). Multivariate analysis revealed that CPFE was an independent predictor of overall survival (hazard ratio: 1.734; 95% confidence interval: 1.060–2.791; P = 0.028). Our results indicate that LC‐CPFE has a distinct histological phenotype, can arise from the dysplastic epithelium in the fibrotic area around the tumor, and is associated with poor survival outcomes.

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Section: Discussionmentioning

confidence: 98%

The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema

et al. 2016

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“…In a large retrospective analysis, about one in 20 patients presenting with lung cancer had a concomitant IPF, the majority of tumors being squamous cell, small in size, and peripheral in location arising in an area of honeycombing. Th e outcome of therapy for lung cancer was extremely poor regardless of tumor stage or severity of IPF, 10 although other studies demonstrated that surgery can be off ered to properly selected patients with ILD. 11…”

Section: Clinical Discussionmentioning

confidence: 99%

A 79-Year-Old Man With Interstitial Lung Disease and Cryptic Area of High 18 Fluorodeoxyglucose Uptake in Left Upper Lobe

Rapicetta¹,

Lococo²,

Carbonelli³

et al. 2015

Chest

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Seven years after left hemicolectomy and radical lymph nodal dissection followed by adjuvant chemotherapy for colorectal cancer (histotype, adenocarcinoma; stage, pT3N2M0; grading, G2), a slight increase in carcinoembryonic antigen levels (6.2 ng/mL; range, 0-5 ng/mL) was detected in a 79-year-old man. He was a heavy smoker with history of an interstitial fibrotic lung disease with associated areas of emphysema.

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“…Lung cancer in IPF patients generally starts in peripheral areas of lung fibrosis. If fine needle aspiration biopsy (FNAB) can not be performed or is not diagnostic, the management of these patients becomes difficult (16). The international guidelines for the diagnosis and treatment of IPF do not provide a clear strategy on how to manage these patients whose survival is reduced by the presence of the highly suspected or even histologically confirmed lung cancer (1,9,10).…”

Section: Discussionmentioning

confidence: 99%

“…It generally occurs in the peripheral areas of the lower lobes, where fibrotic changes are predominant. In particular, LC develops from honeycomb areas or in the border between honeycombing and non fibrotic areas and the squamous cell carcinoma is the predominant histological type (16,17). Invasive diagnostic or therapeutic procedures for neoplasms promote the development of Acute exacerbations (AE) in 80% of IPF patients and the lung surgical treatment puts about 1/5 of them at high risk of death (17,18).…”

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confidence: 99%

Lung Cancer in Patients with Severe Idiopathic Pulmonary Fibrosis: Critical Aspects

Bargagli

Bonti

Ferrari

et al. 2017

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Abstract. Idiopathic pulmonary fibrosis (IPF) is a rare interstitial lung disease limited to the lung with an undefined etiopathogenesis and a very short life expectancy (less than 5 years). IPF susceptibility has been associated with several genetic and environmental risk factors and the prognosis isIdiopathic pulmonary fibrosis (IPF) is an interstitial lung disease with poor prognosis and an undefined etiopathogenesis. Several genetic and environmental risk factors for IPF have been identified including cigarette smoking, metal dust and other pollutant exposure, genetic mutations and polymorphisms (1-5). IPF prognosis is really poor (less than 5 years) and is conditioned by comorbidities negatively affecting patients' quality of life and survival (e.g. gastro-esophageal reflux, depression, venous thromboembolism, pulmonary hypertension and other cardiovascular disorders, and lung cancer) (6-10). The incidence of pulmonary neoplasm is much higher in IPF patients than in the general population (11). Ozawa et al. (12) for instance, reported 3.3%, 15.4% and 54.7% of lung cancer incidence in IPF patients after one, five and ten years of follow-up, respectively (12). Common mechanisms shared by the two diseases remain unknown. An aberrant expression of miRNAs regulating non-small cell lung cancer (NSCLC) and IPF has been suggested together with a crucial role of tyrosine kinase inhibitor directed against growth factors (plateletderived growth factor, vascular endothelial growth factor and fibroblast growth factor) (13,14).Lung cancer (LC) significantly reduces survival of IPF patients, including patients with combined pulmonary emphysema and pulmonary fibrosis (15). It generally occurs in the peripheral areas of the lower lobes, where fibrotic changes are predominant. In particular, LC develops from honeycomb areas or in the border between honeycombing and non fibrotic areas and the squamous cell carcinoma is the predominant histological type (16,17). Invasive diagnostic or therapeutic procedures for neoplasms promote the development of Acute exacerbations (AE) in 80% of IPF patients and the lung surgical treatment puts about 1/5 of them at high risk of death (17,18). A perioperative Pirfenidone treatment has recently been proposed to reduce the incidence of postoperative acute events (18)(19)(20). In this context, the therapeutic management of LC is a difficult task and is still questioned, especially in IPF patients with severe fibrotic involvement, whether the tumor should be treated or not (21,22). Although Lee et al. (15) reported that radiotherapy and surgical treatments of LC result in a reduced survival of IPF patients, according to Kumar et al. (19) lung resection in selected cases can improve their survival. Furthermore, Tomassetti and colleagues (21) have suggested that in mild IPF patients the sublobar resection in 773

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Radiological Characteristics, Histological Features and Clinical Outcomes of Lung Cancer Patients with Coexistent Idiopathic Pulmonary Fibrosis

Abstract: At our centre, 1/20 patients with lung cancer have concomitant IPF. The majority of these tumours are small in size, peripheral in location and squamous cell carcinoma; in an area of honey combing. The outcome for concomitant lung cancer and IPF regardless of stage or therapy is poor.

Cited by 56 publications

References 33 publications

The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema

The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema

A 79-Year-Old Man With Interstitial Lung Disease and Cryptic Area of High 18 Fluorodeoxyglucose Uptake in Left Upper Lobe

Lung Cancer in Patients with Severe Idiopathic Pulmonary Fibrosis: Critical Aspects

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