Lung cancer in patients with combined pulmonary fibrosis and emphysema revisited with the 2015 World Health Organization classification of lung tumors.

Abstract

Combined pulmonary fibrosis and emphysema (CPFE) is a newly defined entity that comprises upper lobe emphysema and lower lobe fibrosis. Patients with CPFE are at high risk for lung cancer and have poor prognoses. To investigate the clinical and pathological characteristics of lung cancer with CPFE, lung cancers with CPFE and non-CPFE interstitial lung disease (ILD) were reevaluated by 2015 WHO classification and compared. A total of 60 patients with histologically proven lung cancer were selected from the database of two institutional medical centers. The subjects included 35 patients with combined lung cancer and CPFE, and 25 patients with lung cancer and non-CPFE ILD. The clinical and pathological characteristics were evaluated and compared between the two groups. CPFE group had more current smokers but relatively normal pulmonary function compared with non-CPFE group. The majority of the cancers in CPFE were located in the lower lobes (24 of 35 cases), where the pulmonary fibrosis visualized as reticular opacities was predominant. Keranitizing subtype of squamous cell carcinoma was prevalent in lung cancers with CPFE. Poor prognoses were found both for CPFE and non-CPFE group because of advanced stage. Lung cancers with CPFE show some unique clinical characteristics, and the distinct histological subtype may have therapeutic implication.