Impact of combined pulmonary fibrosis and emphysema on surgical complications and long-term survival in patients undergoing surgery for non-small-cell lung cancer

Meta-analysis: clinical features and treatments of lung cancer in combined pulmonary fibrosis and emphysema

BACKGROUND AND AIM

There are many epidemiological pieces of evidence that show combined pulmonary fibrosis and emphysema (CPFE) patients have an increased risk of lung cancer. We conducted a systematic review of all published data to define the characteristics and treatments of lung cancer that develops in CPFE by performing a meta-analysis.

METHODS

Databases(including PubMed, Medline, CNKI, VIP, etc.) were searched to find original articles that related to lung cancer in CPFE(CPFE-LC) patients and a meta-analysis was used to analyze the included 15 articles. Stata17.0 software was performed for this meta-analysis.

RESULTS

Fifteen original studies that assessed 5933 patients were included in this meta-analysis. In the pooled data, people with CPFE-LC were elderly(70.58 years) and heavy smokers( 0.959, 45.793 pack-years), with a male predominance(0.959). Most lung cancer in CPFE was located in the lower lobe(0.533) and obvious areas of pulmonary fibrosis(0.516). Highest prevalence of cellular subtypes of lung cancer in CPFE was squamous carcinoma(SQCC, 0.437) and chemotherapy was the main treatment(0.387). The mortality rate was 0.720(95%CI: 0.657-0.783) and the 5-year survival rate was 0.250(95%CI: 0.133-0.368). The main cause of death was infection(0.268) and respiratory failure was the main cause of death after surgery(0.392).

CONCLUSIONS

Lung cancer in CPFE, most commonly SQCC, presents in elderly heavy smokers with a male, located in the lower lobe of the lung and the areas of fibrosis predominance. Chemotherapy is the main treatment and the optimal treatment remains to be explored.

[Safety Analysis of Perioperative Period in Non-Small Cell Lung Cancer Patients with Comorbid Pneumoconiosis]

Objective

To explore the surgical safety of patients with comorbid non-small cell lung cancer (NSCLC) and pneumoconiosis.

Methods

In this study, the clinical data of 165 NSCLC patients treated at West China Fourth Hospital, Sichuan University from August 2019 to May 2021 were collected. Among them, 21 patients with comorbid pneumoconiosis were included in the pneumoconiosis group, and the remaining 144 patients were included in the general group. Radical resection for lung cancer was performed in both groups. The perioperative clinical data, including preoperative, intraoperative and postoperative indicators, of the two groups were compared and analyzed.

Results

There was no perioperative death in either group. The proportions of male patients and patients with smoking history in the pneumoconiosis group were significantly higher than those in the general group ( P<0.05). The body mass index (BMI), pulmonary ventilation function and diffusion function in the pneumoconiosis group were significantly lower than those in the general group ( P<0.05). There was no significant difference in the median operative time and the median volume of intraoperative blood loss between the pneumoconiosis group and the general group. In the pneumoconiosis group, the proportion of advanced tumors (stage Ⅱ/Ⅲ), incidence of postoperative complications, median duration of postoperative intubation, and postoperative length of hospital stay were higher/longer than those of the normal group ( P<0.05). Compared with the general group, the incidences of lymph node calcification, dense pleural adhesion and surgical method alteration (switching from thoracoscopic surgery to open surgery or video-assisted thoracoscopy) were also significantly higher in the pneumoconiosis group ( P<0.05). Univariate analysis showed that age, smoking history, pneumoconiosis, pulmonary ventilation dysfunction, lymph node calcification, dense pleural adhesion and the volume of intraoperative blood loss were the risk factors for postoperative complications. Further multivariate regression analysis demonstrated that smoking history ( OR=1.37, P<0.05), lymph node calcification ( OR=2.36, P<0.05) and pulmonary ventilation dysfunction ( OR=5.21, P<0.05) were independent risk factors for postoperative complications.

Conclusion

NSCLC patients with comorbid pneumoconiosis face relatively greater risks during the perioperative period when they undergo radical resection for lung cancer. Therefore, the close attention of surgeons and the nursing staff should be raised accordingly.

Impact and prognosis of lung cancer in patients with combined pulmonary fibrosis and emphysema

Background:

Combined pulmonary fibrosis and emphysema (CPFE) is frequently associated with lung cancer. However, the impact and outcomes of lung cancer in patients with CPFE are unclear.

Objective:

We investigated the impact of lung cancer in patients with CPFE in terms of acute exacerbation (AE) and mortality, and identified the mortality predictors of patients with CPFE and lung cancer.

Methods:

We retrospectively reviewed 12-year medical records of patients at the Korea University Guro Hospital. Based on computed tomography findings, we selected CPFE patients with and without lung cancer, and analyzed age, sex, smoking status and history, body mass index, past medical history, pulmonary function, the gender, age, and physiology (GAP) score, AE, and mortality.

Results:

Of 227 CPFE patients, 61 were diagnosed with lung cancer. While 10 of the 61 patients experienced AE, 41 died during the observation period. Lung cancer was a significant predictor of AE (hazard ratio [HR] 3.27, 95% confidence interval [CI ]1.44–7.43, P<0.01) and mortality (HR 4.74, 95% CI 2.55–8.81, P<0.01) in CPFE patients. AE, rather than age, GAP score, or lung cancer stage, was the most significant factor associated with mortality in patients with CPFE and lung cancer (HR 9.20, 95% CI 1.13–74.70, P=0.04).

Conclusions:

Lung cancer has a significant impact on the outcomes of CPFE and is associated with severe complications. AE was the most important mortality predictor in patients with lung cancer combined with CPFE. Therefore, the diagnosis and treatment of lung cancer should be carefully planned in patients with CPFE. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020020)

Combined pulmonary fibrosis and emphysema predicts recurrence following surgery in patients with stage I non-small cell lung cancer

The purpose of this study was to clarify the clinicopathologic characteristics of non-small cell lung cancer (NSCLC) patients with combined pulmonary fibrosis and emphysema (CPFE). We investigated the association between CPFE, the cancer survival, and the pathological features of clinical stage I NSCLC patients. Between 2005 and 2014, 218 consecutive patients with clinical stage I NSCLC underwent complete resection with systematic lymph node dissection. A univariate analysis by log-rank tests was performed to determine the risk factors for recurrence, and the Cox proportional hazards regression model was used to identify potential independent predictors. The 5-year recurrence-free proportion of patients with CPFE was 36%, which was significantly lower than in those without CPFE (82%; p < 0.001). On multivariate analysis, the presence of CPFE was one of the statistically significant independent predictors for tumor recurrence (p = 0.005). Postoperative pathological prognostic factors, including moderate or poor histological differentiation, lymphatic permeation, intratumoral vascular invasion, and lymph node metastasis, were detected more often in patients with CPFE. NSCLC patients with CPFE have histologically more invasive tumors than those without CPFE. In patients with clinical stage I NSCLC, the presence of CPFE was a statistically significant predictor of recurrence.

Clinical characteristics and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema: a systematic review and meta-analysis of 13 studies

Background

The characteristic and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema (CPFE) have long been assessed, but results were controversial. Therefore, we performed a meta-analysis to assess the clinical features and prognosis of lung cancer patients with CPFE.

Methods

The databases PubMed, Embase, and Web of Science (updated to October 1, 2017) were searched for eligible studies. Pooled odds ratios (ORs), weighted mean differences (WMD) or hazard ratios (HRs) with 95% confidence intervals (95% CIs) were used to evaluate the clinicopathological characteristics, the short-term outcome after operation and long-term survival of lung cancer patients with CPFE compared with lung cancer patients without CPFE (fibrosis, emphysema, and normal).

Results

Thirty original studies with 8,050 patients were included in this meta-analysis. The pooled results indicated that lung cancer patients with CPFE were associated with higher age (MD =3.39; 95% CI: 2.12-4.67, P<0.001), male (OR =8.46; 95% CI: 6.36-11.26, P<0.001), ex- or current smoker (OR =39.65; 95% CI: 15.64-100.5, P<0.001), longer smoking history (MD =15.56; 95% CI: 3.73-27.39, P=0.01), lower DLCO% (MD =-13.82; 95% CI: -21.4 to -6.24, P<0.001), squamous cell carcinoma histology (OR =3.55; 95% CI: 2.49-5.05, P<0.001), the lower lobes (OR =1.92; 95% CI: 1.52-2.43, P<0.001), advanced pathological stage (OR =1.55; 95% CI: 1.22-1.96, P<0.001). Lung cancer patients with CPFE had higher 30-day mortality (OR =4.72, 95% CI: 2.06-10.85, P<0.001), 90-day mortality (OR =5.33; 95% CI: 1.39-20.42, P=0.01), and incidence of postoperative complications (OR =5.25, 95% CI: 2.38-11.57, P<0.001). In addition, the lung cancer patients with CPFE had a poorer OS (HR =2.006, 95% CI: 1.347-2.986, P=0.001) than lung cancer patients without CPFE.

Conclusions

This meta-analysis demonstrated that lung cancer patients with CPFE have more aggressive clinical characteristic and a poor prognosis, suggesting that lung cancer patients with CPFE should be early detected, treated reasonably and be taken good care of.

The prognostic impact of combined pulmonary fibrosis and emphysema in patients with clinical stage IA non-small cell lung cancer

PURPOSE

We evaluated the long-term outcomes of clinical stage IA non-small cell lung cancer (NSCLC) patients with combined pulmonary fibrosis and emphysema (CPFE) who underwent lobectomy.

METHODS

We reviewed the chest computed tomography (CT) findings and divided the patients into normal, fibrosis, emphysema and CPFE groups. We evaluated the relationships among the CT findings, the clinicopathological findings and postoperative survival.

RESULTS

The patients were classified into the following groups based on the preoperative chest CT findings: normal lung, n = 187; emphysema, n = 62; fibrosis, n = 8; and CPFE, n = 17. The patients with CPFE were significantly older, more likely to be men and smokers, had a higher KL-6 level and lower FEV 1.0% value and had a higher rate of squamous cell carcinoma. The 5-year overall survival (OS) and disease-free survival rates were as follows: normal group, 82.5 and 76.8%; emphysema group, 80.0 and 74.9%; fibrosis group, 46.9 and 50%; and CPFE group, 36.9 and 27.9%, respectively (p < 0.01). A univariate and multivariate analysis determined that the pathological stage and CT findings were associated with OS.

CONCLUSIONS

CPFE is a significantly unfavorable prognostic factor after lobectomy, even in early-stage NSCLC patients with a preserved lung function.