Lung cancer in connective tissue disease-associated interstitial lung disease: clinical features and impact on outcomes
Lung cancer in connective tissue disease-associated interstitial lung disease: clinical features and impact on outcomes
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DOI：
10.21037/jtd.2017.12.134
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发表时间：
2018-02-01
影响因子：
2.5
通讯作者：
Kasahara, Kazuo
中科院分区：
文献类型：
--
作者：
Watanabe, Satoshi;Saeki, Keigo;Kasahara, Kazuo
背景：肺癌（LC）对特发性肺纤维化患者的生存有不利影响。然而，对于结缔组织病相关间质性肺疾病（CTD-ILD）患者的LC知之甚少。本研究的目的是评估CTD-ILD中LC的患病率和危险因素，以及CTD-ILD合并LC患者的临床特征和生存率。方法：我们对2003年至2016年的CTD-ILD患者进行了单中心回顾性研究。对病理诊断为LC的患者进行鉴定。观察LC的患病率、危险因素、临床特征以及LC对CTD-ILD患者预后的影响。结果：266例CTD-ILD患者中，24例（9.0%）有LC。CTD-ILD合并LC更可能发生在年龄较大、男性和吸烟者中；有类风湿关节炎，常见间质性肺炎，胸部计算机断层扫描显示肺气肿，预测肺一氧化碳弥散量（DLco）%较低；并且没有接受免疫抑制治疗。多因素分析显示患者存在肺气肿[比值比（OR）， 8.473；95%可信区间（CI），2.241-32.033]和未使用免疫抑制治疗（OR, 8.111; 95% CI, 2.457-26.775）是LC的独立危险因素。合并LC的CTD-ILD患者的生存率明显低于未合并LC的患者(10年生存率：28.5% vs. 81.8%， P
Backgrounds: Lung cancer (LC) adversely impacts survival in patients with idiopathic pulmonary fibrosis. However, little is known about LC in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The aim of this study was to evaluate the prevalence of and risk factors for LC in CTD-ILD, and the clinical characteristics and survival of CTD-ILD patients with LC.Methods: We conducted a single-center, retrospective review of patients with CTD-ILD from 2003 to 2016. Patients with pathologically diagnosed LC were identified. The prevalence, risk factors, and clinical features of LC and the impact of LC on CTD-ILD patient outcomes were observed.Results: Of 266 patients with CTD-ILD, 24 (9.0%) had LC. CTD-ILD with LC was more likely in patients who were older, male, and smokers; had rheumatoid arthritis, a usual interstitial pneumonia pattern, emphysema on chest computed tomography scan, and lower diffusing capacity of the lung carbon monoxide (DLco)% predicted; and were not receiving immunosuppressive therapy. Multivariate analysis indicated that the presence of emphysema [odds ratio (OR), 8.473; 95% confidence interval (CI),2.241-32.033] and nonuse of immunosuppressive therapy (OR, 8.111; 95% CI, 2.457-26.775) were independent risk factors for LC. CTD-ILD patients with LC had significantly worse survival than patients without LC (10-year survival rate: 28.5% vs. 81.8%, P