Clinical analysis of 12 cases of lung cancer associated with interstitial lung diseases

Abstract

Objective To understand the clinical features and treatment of lung cancer associated with interstitial lung disease(ILD-Ca).Methods Twelve patients with ILD-Ca were retrospectively studied in Peking Union Medical College Hospital.Their clinical features,chest radiography,pathology,therapy and prognosis were analyzed.Results The mean age at presentation was(61±-8)years,11 were man.Lung cancer was found in(3± 2)years after the diagnosis of ILD.The average smoking index was (26±5)packet · year.There were eight cases of idiopathic pulmonary fibrosis(IPF),three cases of rheumatoid arthritis and one case of nonspecific interstitial lung disease(NSIP).The clinical presentations included dry cough(10/12),shortness of breath(10/12),inspiratory crepitus(10/12)and acropachy (10/12).Those ILD patients had exacerbation of the above(3/12)or hemoptysis(1/12)when they had lung cancer.The cardinal cell types were squamous carcinoma and adenocarcinoma.Besides there were two cases of combined carcinoma(2/12)and one case of non-small cell lung cancer(1/12).The stage of lung cancer was always later(9/12).The pathology of ILD associated with lung cancer included usual interstitial pneumonia and NSIP.The cancer was mostly located in the periphery of the lower lobe (7/12),which was mainly single nodule(9/12).The complication included acute exacerbation of ILD (AE-ILD)(1/12),pulmonary infection(3/12)after lobectomy,chemothepary or radiotherapy of lung cancer.Lung cancer associated with IPF(IPF-Ca)occupied 15％ of all IPF patients.The hospital mortality of IPF-Ca(38％)was higher than the IPF without lung cancer(15％).Conclusions ILD is always combined with lung cancer,which has worse prognosis.Bacause of un-specific clinical presentations and misdiagnosis,ILD-Ca is always ignored.The change of chest radiology is beneficial to early diagnosis.The therapy of lung cancer always results in more severe pulmonary complications,such as AE-ILD.So the treatment needs more careful consideration and monitor. Key words: Interstitial lung disease ; Pulmonary fibrosis ; Lung cancer