Impact of idiopathic pulmonary fibrosis on advanced non-small cell lung cancer survival.
Impact of idiopathic pulmonary fibrosis on advanced non-small cell lung cancer survival.
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DOI：
10.1007/s00432-016-2199-z
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发表时间：
2016-08
影响因子：
3.6
通讯作者：
Bandoh S
中科院分区：
文献类型：
--
作者：
Kanaji N;Tadokoro A;Kita N;Murota M;Ishii T;Takagi T;Watanabe N;Tojo Y;Harada S;Hasui Y;Kadowaki N;Bandoh S
晚期非小细胞肺癌（NSCLC）合并间质性肺病（ILD）患者的临床特征尚未完全阐明。本研究旨在探讨这些患者的临床特征，尤其是特发性肺纤维化（IPF）患者的临床特征。
回顾性分析了218例经病理确诊为NSCLC且接受过化疗和/或分子靶向治疗患者的数据，包括无进展生存期（PFS）、总生存期（OS）、一线治疗的反应以及急性加重（AEs）的发生率。
218例患者中有53例被诊断为ILD，其中34例为IPF。ILD和IPF患者的表皮生长因子受体（EGFR）突变频率明显低于非ILD患者（分别为2%或0%对32%）。ILD和IPF患者的中位PFS和OS均明显短于非ILD患者（PFS分别为118天、92天和196天，OS分别为267天、223天和539天）。多因素分析显示，体能状态差、无EGFR突变以及存在IPF是PFS和OS的不良预后因素。无论是否存在EGFR突变，ILD和IPF患者的疾病控制率（DCR）均明显低于非ILD患者（分别为67%或53%对85%）。在含多西他赛方案化疗期间，ILD患者的AEs发生率明显更高（38例中有7例；18.4%）。
在晚期NSCLC患者中，IPF和ILD均与较低的EGFR阳性率、较低的DCR以及较短的PFS和OS相关。
The clinical features of patients with advanced non-small cell lung cancer (NSCLC) and interstitial lung disease (ILD) have not fully been elucidated. This study aimed to investigate the clinical features of these patients, particularly with idiopathic pulmonary fibrosis (IPF). Data on 218 patients with pathologically confirmed diagnoses of NSCLC who had been treated with chemotherapy and/or molecular targeted therapy were retrospectively analyzed for progression-free survival (PFS), overall survival (OS), responses to first-line therapy, and incidence of acute exacerbations (AEs). Fifty-three of the 218 patients were diagnosed with ILD, and 34 of them with IPF. The frequency of epidermal growth factor receptor (EGFR) mutation was significantly lower in ILD and IPF patients than in non-ILD patients (2 or 0 vs. 32 %, respectively). Median PFS and OS were significantly shorter in both ILD and IPF patients than in non-ILD patients (118, 92, and 196 days for PFS, and 267, 223, and 539 days for OS, respectively). Multivariate analysis showed that poor performance status, absence of EGFR mutation, and presence of IPF were poor prognostic factors for PFS and OS. Disease control rate (DCR) was significantly lower in ILD and IPF patients than in non-ILD patients regardless of the presence of EGFR mutation (67 or 53 vs. 85 %, respectively). The incidence of AEs of ILD was significantly higher during chemotherapy with docetaxel-containing regimens (seven of 38; 18.4 %). Both IPF and ILD were associated with lower EGFR positivity, lower DCR, and shorter PFS and OS in advanced NSCLC patients.