Radiological characteristics, histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis

Our plain-English summary of Radiological characteristics, histological features and clinical outcomes of lung cancer patients with coexistent idiopathic pulmonary fibrosis, by K.A. Khan, M.P. Kennedy, E. Moore, et al (Lung, 2015).

The study

• Authors: K.A. Khan, M.P. Kennedy, E. Moore, L. Crush, S. Prendeville, M.M. Maher, L. Burke, M.T. Henry
• Journal: Lung
• Published: 2015;193(1):71-7
• Cited by: 54 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Despite advances in diagnosis and management, the outcomes for both lung cancer and idiopathic pulmonary fibrosis (IPF) are still unfavourable. The pathophysiology and outcomes for patients with concomitant lung cancer and IPF remains unclear.

Methodology: A retrospective analysis was performed of all patients presenting with concomitant IPF and lung cancer to our centre over a 3-year period. Patients with connective tissue disease, asbestos exposure, sarcoidosis, previous thoracic radiation, radiological evidence of fibrosis but no histological confirmation of lung cancer, or the use of medications known to cause pulmonary fibrosis were excluded. We describe clinical, radiological and pathological characteristics of this group. We also report the response to standardized lung cancer therapy in this cohort.

Results: Of 637 lung cancer patients, 34 were identified with concomitant IPF (5.3 %) and all were smokers. 85 % had non-small cell lung cancer, 41 % were squamous cell cancers. The majority of tumours were located in the lower lobes, peripheral and present in an area of honeycombing. Despite the fact that approximately 2/3rds of the patients had localised or locally advanced lung cancer, the outcome of therapy for lung cancer was extremely poor regardless of tumour stage or severity of IPF.

Conclusions: 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.

In plain English

This study from Cork University Hospital, Ireland, reviewed all patients with a histologically proven diagnosis of primary lung cancer from August 2008 to December 2011 to find those who also had idiopathic pulmonary fibrosis (IPF), a scarring lung disease. Patients with asbestos exposure were excluded, so the study does not address asbestos-related disease. Of 637 lung cancer patients, 34 (5.3%) had IPF, and all were current or former smokers. Thirty of the 34 had non-small cell lung cancer, and squamous cell carcinoma was the most common type (41%). On CT, 28 tumours lay in the outer lung within areas of honeycomb scarring. By the time of analysis, 30 of the 34 had died. Survival did not differ significantly by treatment (surgery, radiotherapy, chemo-radiotherapy, or supportive care only) or by cancer stage. In the 19 patients tested for lung diffusion capacity before treatment, survival also did not differ significantly by IPF severity, with results above versus below 35% compared. The authors concluded that treatment made no significant difference to these patients' poor survival. They noted that the small number of patients limited the study's power, so real survival differences might still exist.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective consecutive case series from a single hospital's lung cancer database
• Who was studied: 34 patients with both lung cancer and IPF, found among 637 patients with histologically proven primary lung cancer diagnosed August 2008 to December 2011 at a regional tertiary referral hospital (Cork University Hospital, Ireland). There were 22 men and 12 women, and all were smokers.
• Exposure: Asbestos was not studied: patients with asbestos exposure were excluded. All patients were smokers (26 ex-smokers and 8 current smokers), with a mean of 44.94 pack-years (range 5 to 120).
• Main results:
  • All 34 patients with lung cancer and IPF were smokers, with a mean of 44.94 pack-years.
  • 30 of the 34 patients (88%) had non-small cell lung carcinoma. Squamous cell carcinoma was the most common cell type (41%).
  • Among the 30 patients with non-small cell lung cancer, 14 (47%) had localised disease (stage I and II) and 7 (23%) had locally advanced disease (stage IIIA).
  • On CT, 28 tumours (82%) were located peripherally and invaded areas of honeycombing. The median tumour size was 3.6 cm (range 0.6 to 9.5 cm).
  • In half of the surgically resected squamous cell tumours, the pathologists saw a transition from abnormal (metaplastic) squamous lining cells within areas of usual interstitial pneumonia and honeycombing to invasive carcinoma.
  • At the time of analysis, 30 of the 34 patients (88%) had died. The confirmed cause of death was known for only 8 of them.
  • Across all 34 patients, survival did not differ significantly by type of cancer therapy (p value 0.74) or by lung cancer stage (p value 0.251).
  • In the 19 of 34 patients whose lung diffusion capacity (DLCO) was measured before cancer therapy, survival did not differ by IPF severity, comparing DLCO above versus below 35% (p value 0.981).
• The authors' conclusion: The authors concluded that treatment for lung cancer made no significant difference to the overall poor long-term survival of patients with both lung cancer and IPF, regardless of cancer stage or IPF severity. They also stated that patients should be carefully selected before definitive cancer therapy is considered.
• Limitations the authors state:
  • The small number of cases gave the study limited power to detect statistical differences, so real survival differences between groups might exist even where p values were not significant.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer.

Medical terms in this study, explained in our Lexicon: Lung Cancer, Idiopathic, Pulmonary Fibrosis, Asbestos Exposure, Fibrosis, Non-Small Cell Lung Cancer, Squamous Cell, Honeycombing.

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