Tzouvelekis Argyris, Antoniou Katerina, Kreuter Michael, Evison Matthew, Blum Torsten G, Poletti Venerino, Grigoriu Bogdan, Vancheri Carlo, Spagnolo Paolo, Karampitsakos Theodoros, Bonella Francesco, Wells Athol, Raghu Ganesh, Molina-Molina Maria, Culver Daniel A, Bendstrup Elisabeth, Mogulkoc Nesrin, Elia Stefano, Cadranel Jacques, Bouros Demosthenes
Dept of Internal and Respiratory Medicine, Medical School University of Patras, Patras, Greece.
Dept of Respiratory Medicine, University of Crete, Athens, Greece.
ERJ Open Res. 2021 Jan 25;7(1). doi: 10.1183/23120541.00529-2020. eCollection 2021 Jan.
Currently there is major lack of agreement on the diagnostic and therapeutic management of patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. Our aim was to identify variations in diagnostic and management strategies across different institutions and provide rationale for a consensus statement on this issue.
This was a joint-survey by European Respiratory Society (ERS) Assemblies 8, 11 and 12. The survey consisted of 25 questions.
Four hundred and ninety-four (n=494) physicians from 68 different countries and five continents responded to the survey. Ninety-four per cent of participants were pulmonologists, 1.8% thoracic surgeons and 1.9% oncologists; 97.7% were involved in multidisciplinary team approaches on diagnosis and management. Regular low-dose high-resolution computed tomography (HRCT) scan was used by 49.5% of the respondents to screen for lung cancer in IPF. Positron emission tomography (PET) scan and endobronchial ultrasound (EBUS) is performed by 60% and 88% to diagnose nodular lesions with mediastinal lymphadenopathy in patients with advanced and mild IPF, respectively. Eighty-three per cent of respondents continue anti-fibrotics following lung cancer diagnosis; safety precautions during surgical interventions including low tidal volume are applied by 67%. Stereotactic radiotherapy is used to treat patients with advanced IPF (diffusing capacity of the lung for carbon monoxide ( ) <35%) and otherwise operable nonsmall cell lung cancer (NSCLC) by 54% of respondents and doublet platinum regimens and immunotherapy for metastatic disease by 25% and 31.9%, respectively. Almost all participants (93%) replied that a consensus statement for the management of these patients is highly warranted.
The diagnosis and management of IPF-lung cancer (LC) is heterogeneous with most respondents calling for a consensus statement.
目前，对于特发性肺纤维化（IPF）合并肺癌患者的诊断和治疗管理，人们尚未达成主要共识。我们的目的是确定不同机构在诊断和管理策略上的差异，并为就该问题达成共识声明提供依据。
这是欧洲呼吸学会（ERS）第8、11和12分会的联合调查。该调查由25个问题组成。
来自六大洲68个不同国家的494名医生回复了该调查。94%的参与者是肺科医生，1.8%是胸外科医生，1.9%是肿瘤学家；97.7%的人参与了诊断和管理的多学科团队方法。49.5%的受访者使用定期低剂量高分辨率计算机断层扫描（HRCT）来筛查IPF患者的肺癌。分别有60%和88%的受访者对晚期和轻度IPF患者进行正电子发射断层扫描（PET）和支气管内超声（EBUS）以诊断伴有纵隔淋巴结肿大的结节性病变。83%的受访者在肺癌诊断后继续使用抗纤维化药物；67%的人在手术干预期间采取包括低潮气量在内的安全预防措施。54%的受访者使用立体定向放射疗法治疗晚期IPF（一氧化碳肺弥散量（ ）<35%）且可手术的非小细胞肺癌（NSCLC）患者，分别有25%和31.9%的人对转移性疾病使用双联铂类方案和免疫疗法。几乎所有参与者（93%）都回答说，非常有必要就这些患者的管理达成共识声明。
IPF合并肺癌（LC）的诊断和管理存在异质性，大多数受访者呼吁达成共识声明。
