Ding Xiaorui, Zhou Wanqing, Zhong Guanning, Chen Ranxun, Xu Qingqing, Chen Lulu, Zhang Yingwei, Zhuang Yi, Miao Liyun, Dai Jinghong
Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Transl Lung Cancer Res. 2025 May 30;14(5):1786-1803. doi: 10.21037/tlcr-2025-235. Epub 2025 May 22.
The association of interstitial lung disease (ILD) with lung cancer (LC) has generated increased research interest in recent years. We aimed to characterize the clinical features and prognostic factors of patients with ILD and LC and to develop a 1-year mortality risk prediction model for these patients.
The retrospective study enrolled patients with ILD and LC admitted to Nanjing Drum Tower Hospital from 2017 to 2022. The demographic data, histological type and staging of LC, high-resolution computed tomography (HRCT) patterns of ILD, laboratory examinations, and therapeutic and follow-up information were collected. The primary endpoint for the prediction model was all-cause 1-year mortality. Logistic regression analysis was used to identify risk predictors and further establish a nomogram to predict 1-year mortality. Area under the curve (AUC), calibration curves, and decision curves were used to assess the utility of the nomogram.
A total of 206 patients with concurrent ILD and LC were included. Adenocarcinoma was the most common pathological subtype (94/206, 45.6%), followed by squamous cell carcinoma (55/206, 26.7%) and small-cell lung cancer (SCLC) (42/206, 20.4%). Moreover, 43.7% (90/206) of tumors were located inside ILD lesions. Among the patients with non-small cell lung cancer (NSCLC), 90 were diagnosed with advanced-stage disease (> stage IIIA) while 28 patients with SCLC were at the extensive phase. The most common HRCT pattern of ILD was usual interstitial pneumonia (UIP) (102/206, 49.5%). The all-cause 1-year mortality rate was 41.3%. The prediction model incorporated age, sex, neutrophil count, and lactate dehydrogenase (LDH) and albumin (Alb) levels. The AUC values in training and internal validation sets were 0.775 and 0.716 respectively. Calibration curves indicated strong consistency, and decision curves confirmed the clinical net benefit achievable at different risk thresholds.
We developed a 1-year mortality risk prediction model for patients with concurrent ILD and LC to identify those with high risk of death and facilitate precise management. Future multicenter studies are needed for further external validation.
近年来，间质性肺疾病（ILD）与肺癌（LC）的关联引发了越来越多的研究兴趣。我们旨在描述ILD合并LC患者的临床特征和预后因素，并为这些患者建立1年死亡风险预测模型。
这项回顾性研究纳入了2017年至2022年在南京鼓楼医院住院的ILD合并LC患者。收集了人口统计学数据、LC的组织学类型和分期、ILD的高分辨率计算机断层扫描（HRCT）模式、实验室检查以及治疗和随访信息。预测模型的主要终点是全因1年死亡率。采用逻辑回归分析确定风险预测因素，并进一步建立列线图以预测1年死亡率。使用曲线下面积（AUC）、校准曲线和决策曲线评估列线图的效用。
共纳入206例ILD合并LC患者。腺癌是最常见的病理亚型（94/206，45.6%），其次是鳞状细胞癌（55/206，26.7%）和小细胞肺癌（SCLC）（42/206，20.4%）。此外，43.7%（90/206）的肿瘤位于ILD病变内。在非小细胞肺癌（NSCLC）患者中，90例被诊断为晚期疾病（>IIIA期），而28例SCLC患者处于广泛期。ILD最常见的HRCT模式是普通型间质性肺炎（UIP）（102/206，49.5%）。全因1年死亡率为41.3%。预测模型纳入了年龄、性别、中性粒细胞计数以及乳酸脱氢酶（LDH）和白蛋白（Alb）水平。训练集和内部验证集的AUC值分别为0.775和0.716。校准曲线显示出很强的一致性，决策曲线证实了在不同风险阈值下可实现的临床净效益。
我们为ILD合并LC患者建立了1年死亡风险预测模型，以识别死亡风险高的患者并促进精准管理。未来需要进行多中心研究以进一步进行外部验证。
