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. 2019 Aug 29;9(1):12561.
doi: 10.1038/s41598-019-49026-y.

Prognosis of non-small-cell lung cancer in patients with idiopathic pulmonary fibrosis

SongYi Han  1   2 , Yeon Joo Lee  1 , Jong Sun Park  1 , Young-Jae Cho  1 , Ho Il Yoon  1 , Jae-Ho Lee  1 , Choon-Taek Lee  1 , Jin-Haeng Chung  3 , Kyung Won Lee  4 , Sang Hoon Lee  5
Affiliations

Prognosis of non-small-cell lung cancer in patients with idiopathic pulmonary fibrosis

SongYi Han et al. Sci Rep. .

Abstract

The risk of lung cancer is higher in idiopathic pulmonary fibrosis (IPF) because both conditions share common risk factors. However, no standard treatment modality for LC in IPF exists due to rare incidence, poor prognosis, and acute exacerbation (AE) of IPF during treatment. We aimed to determine the efficacy of LC treatments and the prognosis in LC patients with IPF according to the LC stage and GAP (gender [G], age [A], and two physiology variables [P]) stage. From 2003 to 2016, 160 retrospectively enrolled patients were classified according to the LC clinical stage and GAP stage. The average (±standard deviation) patient age was 70.1 ± 8.2 years; the cohort predominantly comprised men (94.4%). In GAP stage I, surgery was significantly associated with better survival outcomes in LC. In contrast, no treatment modality yielded significant clinical improvement in GAP stage II/III. The incidences of AE in IPF and its mortality during treatment were 13.8% and 6.3%, respectively. AE occurred commonly in advanced GAP stage. Active treatment should be considered in GAP stage I. The performance status and LC stage should be considered when deciding about the necessity of surgery for patients in advanced GAP stage.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Comparison of survival probability according to treatment modality in GAP stage I (a) and GAP ((gender [G], age [A]), and two physiology variables (P) (FVC and DLCO)) stage system) stage II and III (b). Cox regression models were adjusted for lung cancer clinical stages, Eastern Cooperative Oncology Group (ECOG), primary treatment, and total amount of cigarettes smoked in a lifetime.
Figure 2
Figure 2
Subgroup analysis for survival according to the primary treatment after classifying the patient as GAP ((gender [G], age [A]), and two physiology variables (P) (FVC and DLCO)) stage system) stage and the lung cancer (LC) stage. (a) GAP stage I and LC stages I and II, (b) GAP stage I and LC stage III and IV, (c) GAP stage II and III and LC stage I and II, and (d) GAP stages II and III and LC stage III and IV. In GAP stage I, surgery significantly improved the survival in both early and advanced LC stages (p = 0.023 and p = 0.019). In GAP stages II and III, any treatment modalities failed to significantly improve survival in early or advanced LC stages.
Figure 3
Figure 3
Patient recruitment flow chart. Abbreviation: LC-IPF = lung cancer with idiopathic pulmonary fibrosis; ILD = interstitial lung disease; ECOG = Eastern Cooperative Oncology Group; GAP = gender (G), age (A), and two physiology variables (P) (FVC and DLCO) stage system.
See this image and copyright information in PMC

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