The effect of smoking on the development of lung cancer in idiopathic interstitial pneumonia

对66例（男54例，女12例）最初诊断为特发性间质性肺炎（IIP）的患者进行了2 ~ 13年的前瞻性随访研究。作为对照，性别和吸烟史匹配的慢性阻塞性肺疾病（COPD）患者也进行了相同随访期的调查。11例IIP患者（16.7%）发生肺癌。无论COPD组的平均年龄和平均观察时间如何，其发生率均显著高于COPD组（1 / 95,1%）（p<0.01）。除一人外，所有肺癌患者均为男性吸烟者。在临床研究中，IIP合并肺癌的患者未接受类固醇治疗，与未发生肺癌的患者相比，胸廓体积减小。在免疫组化研究中，我们检验了生长因子在IIP肺癌中存在旁分泌机制的假设。为了验证这一点，我们用表皮生长因子（EGF）和EGF受体（EGF- r）对肺标本进行了染色。9例IIP（+）患者中2例EGF染色阳性，44例IIP（-）患者中23例EGF染色阳性。在基质细胞中，9例IIP（+）患者中有5例EGF阳性，44例IIP（-）患者中有6例EGF阳性（p<0.05）。对于EGF-R，两组间无显著差异。提示IIP肺癌的生长可能存在旁分泌机制。

The incidence lung cancer in 66 patients (54 males and 12 females), who were originally diagnosed as having idiopathic interstitial pneumonia (IIP), was studied prospectively by following them 2 to 13 years.As controls, sex and smoking history matched patients with chronic obstructive pulmonary disease (COPD) were also surveyed for the same follow up period.Eleven patients with IIP (16,7%) developed lung cancer.This incidence was significantly higher than that of COPD (1 out of 95,1%) group (p<0.01), regardless of the higher mean age and mean observation period of COPD group.All lung cancer patients except one were male smokers.In clinical findings, IIP patients with lung cancer didn't have steroid treatment and volume decrease in chest roentogenogaram when compared with those who did not develop lung cancer.In the immunohistochemical study, we examined the hypothesis that there is a paracrine mechanism of growth factor in the lung cancer with IIP.To validate it, we stained lung specimen with Epidermal growth factor (EGF) and EGF-receptor (EGF-R).Two of 9 IIP (+) patients and 23 of 44 IIP (-) patients showed positive for EGF staining.In stroma cells, 5 of 9 IIP (+) patients and 6 out of 44 IIP (-) patients exhibited positive for EGF straining (p<0.05).For EGF-R,there weren't any significant difference between the two groups.These results suggest that there might exist paracrine mechanism in the growth of lung cancer with IIP.