Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe

doi:10.1111/resp.14363

Multicenter Study

. 2023 Jan;28(1):56-65.

doi: 10.1111/resp.14363. Epub 2022 Sep 18.

Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe

Theodoros Karampitsakos¹, Paolo Spagnolo², Nesrin Mogulkoc³, Wim A Wuyts⁴, Sara Tomassetti⁵, Elisabeth Bendstrup⁶, Maria Molina-Molina⁷, Effrosyni D Manali⁸, Ömer Selim Unat³, Francesco Bonella⁹, Nicolas Kahn¹⁰, Lykourgos Kolilekas¹¹, Elisabetta Rosi⁵, Leonardo Gori⁵, Claudia Ravaglia¹², Venerino Poletti¹², Zoe Daniil¹³, Thomas Skovhus Prior⁶, Ilias C Papanikolaou¹⁴, Samantha Aso⁷, Stavros Tryfon¹⁵, Despoina Papakosta^{16

17}, Vasillios Tzilas¹⁸, Elisabetta Balestro², Spyridon Papiris⁸, Katerina Antoniou¹⁹, Demosthenes Bouros¹⁸, Athol Wells²⁰, Michael Kreuter¹⁰, Argyris Tzouvelekis¹

Affiliations

¹ Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece.
² Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
³ Department of Pulmonology, Ege University Hospital, Izmir, Turkey.
⁴ Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
⁵ Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy.
⁶ Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
⁷ Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain.
⁸ 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁹ Center for Interstitial and Rare Lung Diseases, Pneumonology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
¹⁰ Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany.
¹¹ 7th Department of Respiratory Medicine, Hospital for Thoracic Diseases, 'SOTIRIA', Athens, Greece.
¹² Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy.
¹³ Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece.
¹⁴ Respiratory Medicine Department, Corfu General Hospital, Corfu, Greece.
¹⁵ Pulmonary Clinic, NHS General Hospital 'G. Papanikolaou', Thessaloniki, Greece.
¹⁶ Pulmonary Department, 'G Papanikolaou' General Hospital, Thessaloniki, Greece.
¹⁷ Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
¹⁸ First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece.
¹⁹ Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Crete, Greece.
²⁰ Interstitial Lung Disease Unit, Ιmperial College London, Royal Brompton and Harefield, London, UK.

PMID: 36117239
DOI: 10.1111/resp.14363

Multicenter Study

Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe

Theodoros Karampitsakos et al. Respirology. 2023 Jan.

. 2023 Jan;28(1):56-65.

doi: 10.1111/resp.14363. Epub 2022 Sep 18.

Authors

Affiliations

¹ Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece.
² Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy.
³ Department of Pulmonology, Ege University Hospital, Izmir, Turkey.
⁴ Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium.
⁵ Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy.
⁶ Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
⁷ Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain.
⁸ 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece.
⁹ Center for Interstitial and Rare Lung Diseases, Pneumonology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany.
¹⁰ Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany.
¹¹ 7th Department of Respiratory Medicine, Hospital for Thoracic Diseases, 'SOTIRIA', Athens, Greece.
¹² Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy.
¹³ Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece.
¹⁴ Respiratory Medicine Department, Corfu General Hospital, Corfu, Greece.
¹⁵ Pulmonary Clinic, NHS General Hospital 'G. Papanikolaou', Thessaloniki, Greece.
¹⁶ Pulmonary Department, 'G Papanikolaou' General Hospital, Thessaloniki, Greece.
¹⁷ Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece.
¹⁸ First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece.
¹⁹ Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Crete, Greece.
²⁰ Interstitial Lung Disease Unit, Ιmperial College London, Royal Brompton and Harefield, London, UK.

PMID: 36117239
DOI: 10.1111/resp.14363

Abstract

Background and objective: There remains a paucity of large databases for patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. We aimed to create a European registry.

Methods: This was a multicentre, retrospective study across seven European countries between 1 January 2010 and 18 May 2021.

Results: We identified 324 patients with lung cancer among 3178 patients with IPF (prevalence = 10.2%). By the end of the 10 year-period following IPF diagnosis, 26.6% of alive patients with IPF had been diagnosed with lung cancer. Patients with IPF and lung cancer experienced increased risk of all-cause mortality than IPF patients without lung cancer (HR: 1.51, [95% CI: 1.22-1.86], p < 0.0001). All-cause mortality was significantly lower for patients with IPF and lung cancer with a monocyte count of either <0.60 or 0.60-<0.95 K/μl than patients with monocyte count ≥0.95 K/μl (HR [<0.60 vs. ≥0.95 K/μl]: 0.35, [95% CI: 0.17-0.72], HR [0.60-<0.95 vs. ≥0.95 K/μl]: 0.42, [95% CI: 0.21-0.82], p = 0.003). Patients with IPF and lung cancer that received antifibrotics presented with decreased all cause-mortality compared to those who did not receive antifibrotics (HR: 0.61, [95% CI: 0.42-0.87], p = 0.006). In the adjusted model, a significantly lower proportion of surgically treated patients with IPF and otherwise technically operable lung cancer experienced all-cause mortality compared to non-surgically treated patients (HR: 0.30 [95% CI: 0.11-0.86], p = 0.02).

Conclusion: Lung cancer exerts a dramatic impact on patients with IPF. A consensus statement for the management of patients with IPF and lung cancer is sorely needed.

Keywords: antifibrotics; idiopathic pulmonary fibrosis; lung cancer; monocyte count; surgery; survival.

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Comment in

Prognosis of IPF patients with comorbid lung cancer: Preventing immortal time bias will make the analysis more valuable.
Yamada S, Ikeda S, Misumi T, Sekine A, Ogura T. Yamada S, et al. Respirology. 2023 Feb;28(2):196-197. doi: 10.1111/resp.14436. Epub 2022 Dec 12. Respirology. 2023. PMID: 36509428 No abstract available.

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References

REFERENCES

1. Raghu GR-JM, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, Behr J, et al. Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Sep 1;198(5):e44-68.
1. Vancheri C. Idiopathic pulmonary fibrosis and cancer: do they really look similar? BMC Med. 2015;13:220.
1. Karampitsakos T, Tzouvelekis A, Chrysikos S, Bouros D, Tsangaris I, Fares WH. Pulmonary hypertension in patients with interstitial lung disease. Pulm Pharmacol Ther. 2018 Jun;50:38-46.
1. Karampitsakos T, Tzilas V, Tringidou R, Steiropoulos P, Aidinis V, Papiris SA, et al. Lung cancer in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther. 2017 Aug;45:1-10.
1. Le Jeune I, Gribbin J, West J, Smith C, Cullinan P, Hubbard R. The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. Respir Med. 2007 Dec;101(12):2534-40.

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[1] Raghu GR-JM, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, Behr J, et al. Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Sep 1;198(5):e44-68.

[2] Raghu GR-JM, Myers JL, Richeldi L, Ryerson CJ, Lederer DJ, Behr J, et al. Diagnosis of idiopathic pulmonary fibrosis. An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med. 2018 Sep 1;198(5):e44-68.

[3] Vancheri C. Idiopathic pulmonary fibrosis and cancer: do they really look similar? BMC Med. 2015;13:220.

[4] Vancheri C. Idiopathic pulmonary fibrosis and cancer: do they really look similar? BMC Med. 2015;13:220.

[5] Karampitsakos T, Tzouvelekis A, Chrysikos S, Bouros D, Tsangaris I, Fares WH. Pulmonary hypertension in patients with interstitial lung disease. Pulm Pharmacol Ther. 2018 Jun;50:38-46.

[6] Karampitsakos T, Tzouvelekis A, Chrysikos S, Bouros D, Tsangaris I, Fares WH. Pulmonary hypertension in patients with interstitial lung disease. Pulm Pharmacol Ther. 2018 Jun;50:38-46.

[7] Karampitsakos T, Tzilas V, Tringidou R, Steiropoulos P, Aidinis V, Papiris SA, et al. Lung cancer in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther. 2017 Aug;45:1-10.

[8] Karampitsakos T, Tzilas V, Tringidou R, Steiropoulos P, Aidinis V, Papiris SA, et al. Lung cancer in patients with idiopathic pulmonary fibrosis. Pulm Pharmacol Ther. 2017 Aug;45:1-10.

[9] Le Jeune I, Gribbin J, West J, Smith C, Cullinan P, Hubbard R. The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. Respir Med. 2007 Dec;101(12):2534-40.

[10] Le Jeune I, Gribbin J, West J, Smith C, Cullinan P, Hubbard R. The incidence of cancer in patients with idiopathic pulmonary fibrosis and sarcoidosis in the UK. Respir Med. 2007 Dec;101(12):2534-40.

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Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe

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Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe

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