Xiaohong Xie, Liqiang Wang, Na Li, Xinqing Lin, Yinyin Qin, Ming Liu, Ming Ouyang, Qian Han, Qun Luo, Shiyue Li, Chunyan Li, Xiaoqian Wang, Shuanying Yang, Wei Huang, Mei Liu, Ping Wang, Chengzhi Zhou
State Key Laboratory of Respiratory Disease, National Clinical Research Center of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of the Respiratory Health, Guangzhou Medical University, Guangzhou, China.
Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Front Mol Biosci. 2021 Mar 31;8:660800. doi: 10.3389/fmolb.2021.660800. eCollection 2021.
Interstitial lung disease with lung cancer (ILD-LC) is rare and its management has not been fully described. This study aimed to investigate the management and prognosis of ILD-LC patients in China.
The present analysis is a retrospective real-world cohort study. Clinical data of ILD-LC patients were obtained from 3 hospitals in China. The overall survival (OS) of patients was analyzed. Univariate and multivariate regression analyses were performed.
One hundred eighty-four ILD-LC patients included were biased toward male (85.3%), smokers (75.5%), idiopathic pulmonary fibrosis (IPF) (58.2%) patients with comorbidities (67.9%) and ECOG-PS score of 1 (65.2%). Most patients were advanced peripheral non-small cell lung cancer. The initial anti-cancer regimen for ILD-LC is mainly chemotherapy, and patients with early-stage LC prefer surgery. In the anti-cancer cohort, the number of ILD-LC patients who underwent the 2nd and 3rd or more anti-cancer regimens were 78 (55.7%) and 32 (22.8%), respectively. In the non-anticancer cohort, the median OS was 3.5 months. In the early-stage cohort, the median OS was 14.2 months in the systematic therapy group; however, the median OS was not reached in the surgery group. In the advanced-stage cohort with systematic therapy, the median OS was 7.2 months. Interstitial pneumonia (IIP) and anti-angiogenesis were associated with OS in the univariate analysis, whereas anti-angiogenesis was an independent protective factor for advanced LC with ILD.
Patients with ILD-LC have very poor prognosis. Appropriate anti-tumor treatment can prolong the survival time of patients who can tolerate it. Targeted therapy and immunotherapy are alternative treatments for LC patients with mild ILD. For ILD patients with advanced LC, antiangiogenic regimens significantly improve the prognosis of the disease.
间质性肺病合并肺癌（ILD-LC）较为罕见，其治疗方法尚未得到充分描述。本研究旨在调查中国ILD-LC患者的治疗及预后情况。
本分析为一项回顾性真实世界队列研究。从中国3家医院获取ILD-LC患者的临床数据。分析患者的总生存期（OS）。进行单因素和多因素回归分析。
纳入的184例ILD-LC患者以男性（85.3%）、吸烟者（75.5%）、特发性肺纤维化（IPF）患者（58.2%）、合并症患者（67.9%）以及ECOG-PS评分为1分（65.2%）者居多。多数患者为晚期周围型非小细胞肺癌。ILD-LC的初始抗癌方案主要为化疗，早期肺癌患者更倾向于手术治疗。在抗癌队列中，接受第2次和第3次或更多抗癌方案的ILD-LC患者分别有78例（55.7%）和32例（22.8%）。在非抗癌队列中，中位总生存期为3.5个月。在早期队列中，系统治疗组的中位总生存期为14.2个月；然而，手术组未达到中位总生存期。在晚期系统治疗队列中，中位总生存期为7.2个月。单因素分析显示间质性肺炎（IIP）和抗血管生成与总生存期相关，而抗血管生成是ILD合并晚期肺癌的独立保护因素。
ILD-LC患者预后很差。适当的抗肿瘤治疗可延长能够耐受治疗的患者的生存时间。靶向治疗和免疫治疗是轻度ILD的肺癌患者的替代治疗方法。对于晚期肺癌的ILD患者，抗血管生成方案可显著改善疾病预后。
