Xu Y
Department of Respiratory and Critical Care Medicine, Chinese PLA General Hospital, Beijing 100853, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2024 Nov 12;47(11):1028-1034. doi: 10.3760/cma.j.cn112147-20240519-00269.
Lung cancer and interstitial lung disease have similar risk factors and pathogenesis. The incidence of lung cancer associated with interstitial lung disease is increasing, and the problem of comorbidity has gradually attracted attention. Early diagnosis of lung cancer associated with interstitial lung disease is difficult, there are many factors influencing treatment, and the prognosis is poor. Interstitial lung disease affects the treatment options for lung cancer in comorbid patients, and lung cancer treatment will increase the risk of acute exacerbation of interstitial lung disease in comorbid patients. For patients with early-stage lung cancer complicated with interstitial lung disease who have surgical indications, the surgical method and extend of resection should be determined on the basis of MDT according to tumor stage and lung function. For patients with early-stage lung cancer combined with interstitial lung disease who are not suitable for surgery, the benefits and risks of complications of the radiotherapy should be weighed, and the appropriate radiotherapy regimen and dose should be selected. Chemotherapy is an effective treatment for patients with advanced lung cancer complicated with interstitial lung disease. Some chemotherapy regimens cause acute progression of interstitial lung disease, and the choice of chemotherapy regimen is particularly important. For lung cancer patients with interstitial lung disease who are positive for driver gene mutations, targeted drugs with low pulmonary toxicity should be selected. Patients with lung cancer combined with interstitial lung disease may benefit from immunotherapy, but the risk of immune-related pneumonia is increased. The occurrence of adverse reactions should be closely monitored during immunotherapy. In the future, more prospective clinical trials are needed to formulate reasonable and effective treatment regimens for lung cancer combined with interstitial lung disease to achieve a better prognosis.
肺癌与间质性肺疾病具有相似的危险因素和发病机制。与间质性肺疾病相关的肺癌发病率呈上升趋势,合并症问题逐渐受到关注。间质性肺疾病合并肺癌的早期诊断困难,影响治疗的因素众多,且预后较差。间质性肺疾病会影响合并症患者肺癌的治疗选择,而肺癌治疗会增加合并症患者间质性肺疾病急性加重的风险。对于有手术指征的早期肺癌合并间质性肺疾病患者,应根据肿瘤分期和肺功能,在多学科诊疗(MDT)的基础上确定手术方式和切除范围。对于不适合手术的早期肺癌合并间质性肺疾病患者,应权衡放疗并发症的利弊,选择合适的放疗方案和剂量。化疗是晚期肺癌合并间质性肺疾病患者的有效治疗方法。一些化疗方案会导致间质性肺疾病急性进展,因此化疗方案的选择尤为重要。对于驱动基因突变阳性的间质性肺疾病肺癌患者,应选择肺毒性低的靶向药物。肺癌合并间质性肺疾病患者可能从免疫治疗中获益,但免疫相关肺炎的风险会增加。免疫治疗期间应密切监测不良反应的发生。未来,需要更多的前瞻性临床试验来制定合理有效的肺癌合并间质性肺疾病治疗方案,以获得更好的预后。