Primary pulmonary carcinoma in patients with idiopathic pulmonary fibrosis
Primary pulmonary carcinoma in patients with idiopathic pulmonary fibrosis
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DOI：
10.4065/77.8.763
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发表时间：
2002-08-01
影响因子：
8.9
通讯作者：
Pankratz, VS
中科院分区：
文献类型：
--
作者：
Aubry, MC;Myers, JL;Pankratz, VS
目的：为了确定特发性肺纤维化（IPF）和原发性肺癌患者和IPF或癌单独的患者之间的区别特征，患者和方法：研究组由24例组织学证实的患者组成。通过检索1990年至1998年的罗切斯特马约诊所数据库确定的普通型间质性肺炎和肺癌。对病历、X线片和组织学切片进行了审查。几个变量，包括生存率进行了比较，在2个对照组，IPF和癌只，通过使用各种统计方法。结果：我们的研究组包括21名男性和3名女性（平均年龄，72.3岁）。其中22人是过去或现在的吸烟者。大约一半的肺癌是偶然发现的。在14例术前计算机断层扫描的患者中，12例外周肿瘤位于纤维化区域。组织学类型以鳞状细胞癌最多见，占16例。几乎所有的患者都接受了手术治疗;近40%的患者发生了术后并发症，3例患者在手术后30天内死亡。IPF和癌症患者中男性与女性的比例为7：1，而仅IPF患者中为1：1（P = 0.003）。IPF和癌症患者的年龄也较大，平均年龄为723岁，而64.4岁（P = 0.001），并且更常吸烟（P = 0.002）。42%的IPF合并癌患者的癌累及下叶，而仅癌患者的癌累及下叶的比例为29%（P = 0.004），主要由鳞状细胞癌组成（P = 0.004）。IPF和肺癌患者诊断为IPF后的平均生存期为23年，诊断为肺癌后的平均生存期为1.6年。这一发现与IPF或单独癌症患者的生存率无显著差异。结论：IPF患者的癌发生于老年男性吸烟者，通常表现为外周鳞状细胞癌。预后很差。
Objective: To identify distinguishing characteristics between patients with idiopathic pulmonary fibrosis (IPF) and primary lung carcinoma and patients with either IPF or carcinoma alone.Patients and Methods: The study group consisted of 24 patients with histologically proven. usual interstitial pneumonia and lung carcinoma identified through a search of the Rochester Mayo Clinic database for 1990 to 1998. Medical records, radiographs, and histological slides were reviewed. Several variables including survival were compared in 2 control groups, IPF only and carcinoma only, by using various statistical methods.Results: Our study group included 21 men and 3 women (mean age, 72.3 years). Twenty-two were past or current smokers. Approximately half of the lung carcinomas were incidental findings. Of the 14 patients with preoperative computed tomographic scans, 12 had peripheral tumors situated in areas of fibrosis. Squamous cell carcinoma was the most common histological type, accounting for 16 cases. Almost all patients underwent surgical treatment; nearly 40% developed postoperative complications, and 3 died within 30 days of surgery. The ratio of men to women in patients with IPF and carcinoma was 7:1 compared with 1:1 in patients with IPF only (P = .003). Patients with IPF and carcinoma were also older, with a mean age of 723 years compared with 64.4 years (P = .001), and were more often smokers (P = .002). Carcinomas involved the lower lobes in 42% of patients with IPF and carcinoma compared with 29% of patients with carcinoma only (P = .004) and were mainly composed of squamous cell carcinoma (P = .004). Mean survival in patients with IPF and lung carcinoma was 23 years after the diagnosis of IPF and 1.6 years after that of carcinoma. This finding did not differ significantly from survival of patients with either IPF or carcinoma alone. However, statistical power was limited.Conclusion: Carcinoma in patients with IPF arises in older male smokers and usually presents as peripheral squamous tell carcinoma. The prognosis is poor.