Lung cancer in connective tissue disease-associated interstitial lung disease: clinical features and impact on outcomes

• Published in: Journal of thoracic disease Vol. 10; no. 2; pp. 799 - 807
• Main Authors: Watanabe, Satoshi, Saeki, Keigo, Waseda, Yuko, Murata, Akari, Takato, Hazuki, Ichikawa, Yukari, Yasui, Masahide, Kimura, Hideharu, Hamaguchi, Yasuhito, Matsushita, Takashi, Yamada, Kazunori, Kawano, Mitsuhiro, Furuichi, Kengo, Wada, Takashi, Kasahara, Kazuo
• Format: Journal Article
• Language: English
• Published: China AME Publishing Company 01-02-2018
• Subjects: Original; Interstitial lung disease (ILD); connective tissue disease (CTD); lung cancer (LC); emphysema
• ISSN: 2072-1439; 2077-6624
• DOI: 10.21037/jtd.2017.12.134

Lung cancer (LC) adversely impacts survival in patients with idiopathic pulmonary fibrosis. However, little is known about LC in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The aim of this study was to evaluate the prevalence of and risk factors for LC in CTD-ILD, and the clinical characteristics and survival of CTD-ILD patients with LC.
We conducted a single-center, retrospective review of patients with CTD-ILD from 2003 to 2016. Patients with pathologically diagnosed LC were identified. The prevalence, risk factors, and clinical features of LC and the impact of LC on CTD-ILD patient outcomes were observed.
Of 266 patients with CTD-ILD, 24 (9.0%) had LC. CTD-ILD with LC was more likely in patients who were older, male, and smokers; had rheumatoid arthritis, a usual interstitial pneumonia pattern, emphysema on chest computed tomography scan, and lower diffusing capacity of the lung carbon monoxide (DLco)% predicted; and were not receiving immunosuppressive therapy. Multivariate analysis indicated that the presence of emphysema [odds ratio (OR), 8.473; 95% confidence interval (CI), 2.241-32.033] and nonuse of immunosuppressive therapy (OR, 8.111; 95% CI, 2.457-26.775) were independent risk factors for LC. CTD-ILD patients with LC had significantly worse survival than patients without LC (10-year survival rate: 28.5%
81.8%, P<0.001).
LC is associated with the presence of emphysema and nonuse of immunosuppressive therapy, and contributes to increased mortality in patients with CTD-ILD.