Survival analysis in lung cancer patients with interstitial lung disease

Abstract

Objective Lung cancer patients with interstitial lung disease (ILD) are prone for higher morbidity and mortality and their treatment is challenging. The purpose of this study is to investigate whether the survival of lung cancer patients is affected by the presence of ILD documented on CT. Materials and methods 146 patients with ILD at initial chest CT were retrospectively included in the study. 146 lung cancer controls without ILD were selected. Chest CTs were evaluated for the presence of pulmonary fibrosis which was classified in 4 categories. Presence and type of emphysema, extent of ILD and emphysema, location and histologic type of cancer, clinical staging and treatment were evaluated. Kaplan-Meier estimates and Cox regression models were used to assess survival probability and hazard of death of different groups. P value < 0.05 was considered significant. Results 5-year survival for the study group was 41% versus 48% for the control group (log-rank test p = 0.0092). No significant difference in survival rate was found between the four different categories of ILD (log-rank test, p = 0.195) and the different histologic types (log-rank test, p = 0.4005). A cox proportional hazard model was used including presence of ILD, clinical stage and age. The hazard of death among patients with ILD was 1.522 times that among patients without ILD (95%CI, p = 0.029). Conclusion Patients with lung cancer and CT evidence of ILD have a significantly shorter survival compared to patients with lung cancer only. Documenting the type and grading the severity of ILD in lung cancer patients will significantly contribute to their challenging management.

A nomogram for the prediction of the survival of patients with advanced non‐small cell lung cancer and interstitial lung disease

“…Our model demonstrated that patients with ILD; lymphocyte counts ≤0.8 × 10 9 /L; docetaxel, vinorelbine, and S‐1 chemotherapy regimens; and PaO 2 s ≤80 mmHg have worse OS. We also showed that patients with NSCLC and ILD have significantly shorter PFS and OS times than do those with NSCLC without ILD, similar to previous reports 15,19,20 . Alomaish et al 15 found that the 5‐year survival rates for patients with lung cancer with and without ILD were 41% and 48%, respectively, and that ILD comorbidity increased the risk of death by 1.522 times.…”

Molecular Mechanisms and Cellular Contribution from Lung Fibrosis to Lung Cancer Development

“…Besides the decrease in FVC and carbon monoxide diffusion capacity (DLCO) in patients who developed both IPF and LC, another aspect to investigate are the histopathological findings. Previous studies have shown that squamous cell carcinoma is the most common histologic type encountered in IPF [51][52][53][54][55][56][57][58][59][60][61][62]. This aspect would highlight the importance of considering older patients with a diagnosis of IPF who have a long and heavy history of smoking and whose median FVC and DLCO are slightly lower than normal [63].…”

“…Indeed, it has been thought that patients with a very rapid decrease in FVC and consequent IPF progression are more sensitive to lung cancer development; however, further studies will need to be conducted to clarify the common factors between cancer and IPF. A recent study demonstrated a median time from IPF to lung cancer of 38 months [53], although Tomassetti et al [52] found the time to be around 30 months. Besides the decrease in FVC and carbon monoxide diffusion capacity (DLCO) in patients who developed both IPF and LC, another aspect to investigate are the histopathological findings.…”

“…One of the most interesting approaches was to analyze the period of onset of lung cancer in IPF-LC patients. In 2021, Alomaish H. et al [53] reported a LC incidence of 13,5% IPF patients. Because lung cancer has a high incidence in patients with IPF having an important impact on the survival of these patients, the scientific community has focused its attention on identifying predictive factors for lung cancer in IPF patients [54][55][56].…”

Treating lung cancer in patients with interstitial lung disease: what do we know?

“…In addition to progressive decline in lung function and AE-ILD, patients with IPF are at risk for pulmonary hypertension, venous thromboembolism, and lung cancer (6)(7)(8). Patients with coexistent ILD and lung cancer have a worse survival than patients with lung cancer alone (9).…”