Prognosis of non-small-cell lung cancer in patients with idiopathic pulmonary fibrosis

Abstract

<b>Background:</b> The risk of lung cancer is higher in idiopathic pulmonary fibrosis, because they share common risk factors. However, the standard treatment modality for lung cancer in idiopathic pulmonary fibrosis has yet to be established due to its rare incidence, poor prognosis of idiopathic pulmonary fibrosis, and acute exacerbation during treatment. <b>Objectives:</b> We aimed to determine the efficacy of lung cancer treatment, and the treatment modality associated with a better prognosis in lung cancer patients with idiopathic pulmonary fibrosis according to lung cancer stage and gender, age, and physiologic variables, namely, forced vital capacity and diffuse capacity for carbon monoxide (GAP) system. <b>Methods:</b> From 2003 to 2016, 160 patients were enrolled retrospectively and classified according to the lung cancer clinical stage and GAP stage. <b>Results:</b> the average patient age was 70.1±8.2 years, and the cohort was comprised predominantly of men (94.4%). In GAP stage I, surgery was significantly associated with better survival outcomes in both early and advanced lung cancer (p=0.035 and p=0.012, respectively). In contrast, no treatment modality yielded significant clinical improvement in GAP stage II and III. The incidence of and mortality rate due to acute exacerbation of idiopathic pulmonary fibrosis during treatment were 13.8% and 6.3%, respectively. <b>Conclusions:</b> Active treatment should be considered in GAP stage I. Meanwhile, no beneficial therapeutic modalities were found for high GAP stage; the performance status and lung cancer stage should be considered when deciding for the necessity of surgery for patients in this stage.