Lung Cancer in Combined Pulmonary Fibrosis and Emphysema: A Systematic Review and Meta-Analysis.

Hyun Jung Koo,Sania Alblushi,Jung Bok Lee,Kyung-Hyun Do,Sang Min Lee,Toby M Maher

doi:10.1371/journal.pone.0161437

Abstract

PurposePatients with combined pulmonary fibrosis and emphysema (CPFE) have been suggested to have an increased risk of lung cancer. We conducted a systematic review of all published data and performed a meta-analysis to define the characteristics of lung cancer that develops in CPFE.MethodWe searched Pubmed, Embase, and Cochrane to find original articles about lung cancer and CPFE published prior to September 2015. All titles/abstracts were reviewed by two radiologists to identify articles that used predefined selection criteria. Summary estimates were generated using a random-effect model and odds ratios (ORs) to develop squamous cell carcinoma (SqCC) were calculated. Kaplan–Meier survival curves were obtained for the survival of patients with CPFE and non-CPFE.ResultsNine original articles that assessed 620 patients were included in this review. In the pooled data, patients were older age (70.4 years), almost all were heavy smokers (53.5 pack years), and males were predominant (92.6%). SqCC was the most common type (42.3%), followed by adenocarcinoma (34.4%). Compared with lung cancer population with an otherwise normal lung, the OR to develop SqCC in CPFE was 9.06 (95% CI, 6.08–13.5). The ORs in CPFE compared with lung cancers that developed in lungs with fibrosis or emphysema were also higher. The median survival for CPFE patients with lung cancer (19.5 months) was significantly shorter than in non-CPFE (53.1 months).ConclusionsLung cancer in CPFE, most commonly SqCC, presents in elderly heavy smokers with a male predominance. The median survival for CPFE patients with lung cancer is 19.5 months.

Highlights

Patients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) are at an increased risk of developing lung cancer, especially in the case of male smokers [1,2,3]
Compared with lung cancer population with an otherwise normal lung, the odds ratios (ORs) to develop squamous cell carcinoma (SqCC) in combined pulmonary fibrosis and emphysema (CPFE) was 9.06
The ORs in CPFE compared with lung cancers that developed in lungs with fibrosis or emphysema were higher

Summary

Introduction

Patients with idiopathic pulmonary fibrosis (IPF) or chronic obstructive pulmonary disease (COPD) are at an increased risk of developing lung cancer, especially in the case of male smokers [1,2,3]. Several previous studies have suggested that patients with CPFE can present distinct clinical characteristics that are associated with different outcomes [7, 8]. CPFE has been associated with a high risk of developing lung cancer (up to 46%) [7], and is more prevalent than fibrosis in lung cancer patients [9]. The overall survival of CPFE patients with lung cancer has been reported in several studies [9,10,11, 13, 14], and the results have varied. Lung cancer patients without CPFE exhibit better survival outcomes compared with patients with CPFE [9], CPFE may not be an independent prognostic factor in lung cancer patients with idiopathic interstitial pneumonia [14]

Methods

Results

Conclusion