Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
PLoS One. 2021 Sep 7;16(9):e0255375. doi: 10.1371/journal.pone.0255375. eCollection 2021.
Lung cancer patients with interstitial lung disease (ILD) are prone for higher morbidity and mortality and their treatment is challenging. The purpose of this study is to investigate whether the survival of lung cancer patients is affected by the presence of ILD documented on CT.
146 patients with ILD at initial chest CT were retrospectively included in the study. 146 lung cancer controls without ILD were selected. Chest CTs were evaluated for the presence of pulmonary fibrosis which was classified in 4 categories. Presence and type of emphysema, extent of ILD and emphysema, location and histologic type of cancer, clinical staging and treatment were evaluated. Kaplan-Meier estimates and Cox regression models were used to assess survival probability and hazard of death of different groups. P value < 0.05 was considered significant.
5-year survival for the study group was 41% versus 48% for the control group (log-rank test p = 0.0092). No significant difference in survival rate was found between the four different categories of ILD (log-rank test, p = 0.195) and the different histologic types (log-rank test, p = 0.4005). A cox proportional hazard model was used including presence of ILD, clinical stage and age. The hazard of death among patients with ILD was 1.522 times that among patients without ILD (95%CI, p = 0.029).
Patients with lung cancer and CT evidence of ILD have a significantly shorter survival compared to patients with lung cancer only. Documenting the type and grading the severity of ILD in lung cancer patients will significantly contribute to their challenging management.
患有间质性肺疾病（ILD）的肺癌患者发病率和死亡率较高，其治疗具有挑战性。本研究旨在探讨胸部 CT 上记录的ILD 是否会影响肺癌患者的生存。
回顾性纳入了 146 例初诊胸部 CT 显示ILD 的患者作为研究组，同时选择了 146 例无ILD 的肺癌对照患者。评估胸部 CT 上是否存在肺纤维化，并将其分为 4 类。评估肺气肿的存在和类型、ILD 和肺气肿的程度、癌症的位置和组织学类型、临床分期和治疗。使用 Kaplan-Meier 估计和 Cox 回归模型评估不同组的生存概率和死亡风险。P 值<0.05 被认为具有统计学意义。
研究组的 5 年生存率为 41%，对照组为 48%（对数秩检验，P=0.0092）。ILD 的四个不同类别（对数秩检验，P=0.195）和不同的组织学类型（对数秩检验，P=0.4005）之间的生存率无显著差异。使用包括ILD、临床分期和年龄的 Cox 比例风险模型。ILD 患者的死亡风险是无ILD 患者的 1.522 倍（95%CI，P=0.029）。
与仅患有肺癌的患者相比，胸部 CT 显示有ILD 的肺癌患者的生存率显著缩短。记录肺癌患者ILD 的类型和严重程度将对其具有挑战性的管理产生重大影响。
