特发性肺纤维化患者的原发性肺癌

Primary pulmonary carcinoma in patients with idiopathic pulmonary fibrosis.

作者信息

Aubry Marie-Christine, Myers Jeffrey L, Douglas William W, Tazelaar Henry D, Washington Stephens Tanya L, Hartman Thomas E, Deschamps Claude, Pankratz V Shane

机构信息

Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minn 55905, USA.

出版信息

Mayo Clin Proc. 2002 Aug;77(8):763-70. doi: 10.4065/77.8.763.

DOI:10.4065/77.8.763

PMID:12173712

Abstract

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 72.3 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 2.3 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 cell carcinoma. The prognosis is poor.

摘要

目的

确定特发性肺纤维化（IPF）合并原发性肺癌患者与单纯IPF或单纯肺癌患者之间的区别特征。

患者与方法

研究组由24例经组织学证实为普通型间质性肺炎合并肺癌的患者组成，这些患者是通过检索罗切斯特梅奥诊所1990年至1998年的数据库确定的。对病历、X光片和组织学切片进行了回顾。通过各种统计方法，在两个对照组（仅IPF组和仅癌症组）中比较了包括生存率在内的几个变量。

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）。22人曾是或现在是吸烟者。大约一半的肺癌是偶然发现的。在14例术前行计算机断层扫描的患者中，12例有位于纤维化区域的周围型肿瘤。鳞状细胞癌是最常见的组织学类型，占16例。几乎所有患者都接受了手术治疗；近40%出现术后并发症，3例在术后30天内死亡。IPF合并癌症患者的男女比例为7:1，而仅IPF患者的男女比例为1:1（P = 0.003）。IPF合并癌症的患者年龄也更大，平均年龄为72.3岁，而仅IPF患者为64.4岁（P = 0.001），且更常为吸烟者（P = 0.002）。42%的IPF合并癌症患者的癌灶累及下叶，而仅癌症患者中这一比例为29%（P = 0.004），且主要为鳞状细胞癌（P = 0.004）。IPF合并肺癌患者在诊断IPF后平均生存2.3年，诊断癌症后平均生存1.6年。这一结果与单纯IPF或单纯肺癌患者的生存率无显著差异。然而，统计效能有限。