Emphysema does not worsen lung cancer prognosis beyond pulmonary fibrosis

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By Sarah Pritchard, medwireNews Reporter

Patients with combined pulmonary fibrosis and emphysema (CPFE) who are undergoing treatment for advanced lung cancer do not have a significantly worse prognosis than their counterparts with isolated idiopathic interstitial pneumonias (IIPs), report Japanese researchers.

Indeed, their study findings show that age, cancer performance status (PS), percentage predicted vital capacity (%VC; indicating pulmonary function) and serum lactate dehydrogenase (LDH; a marker of damaged pneumocytes) are the most significant predictors of poor prognosis, rather than the presence of emphysema or type of treatment given.

The results failed to confirm the team’s initial hypothesis that “CPFE may indicate significantly increased risk of lung cancer compared with either chronic obstructive pulmonary disease or isolated pulmonary fibrosis alone.”

The researchers, led by Yugi Minegishi, from Nippon Medical School in Tokyo, retrospectively reviewed the medical records of 151 lung cancer patients with IIPs, of whom 58.3% met the criteria for CPFE on computed tomography. While the rate of idiopathic pulmonary fibrosis was similar between CPFE and non-CPFE patients, at 54.5% and 61.3%, respectively, those with CPFE had a significantly greater fibrosis score and a significantly reduced percentage predicted diffusing capacity of the lung for carbon monoxide.

Patients were classed as having an acute exacerbation (AE) of IIPs if they had an exacerbation of dyspnoea within a month, newly developed diffuse pulmonary opacities on chest scans, a decrease in arterial oxygen tension of more than 10 mmHg and no heart failure or infectious lung diseases.

While there were no differences in the type of treatment CPFE and non-CPFE patients underwent initially, AE was more common among CPFE than non-CPFE patients undergoing surgery and best supportive care (26.9 vs 15.8%, and 45.0 vs 18.2%, respectively).

Furthermore, median overall survival was nonsignificantly different according to emphysema status, at 23.7 months and 20.3 months for CPFE and non-CPFE patients, respectively. However, this trend was reversed among those who received chemotherapy as first-line treatment, at a respective 14.8 versus 21.6 months.

Multivariate analysis revealed that age over 68 years, an Eastern Cooperative Oncology Group PS of 1–3 versus 0, a %VC less than 80% and an LDH level of at least 244 IU/L significantly predicted poor prognosis with hazard ratios of 1.1, 3.8, 3.2 and 2.8, respectively.

Minegishi and co-workers believe their results indicate that pulmonary fibrosis, but not emphysema, may influence the prognosis of lung cancer with CPFE, and that this, as well as isolated IIPs, may operate via similar mechanisms for AE.

“Therefore, we conclude that it is not necessary to adjust the treatment strategy for lung cancer with IIPs for the existence of emphysema at this time,” they write in Lung Cancer.

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