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Combined pulmonary fibrosis and emphysema and idiopathic pulmonary fibrosis in non-small cell lung cancer: impact on survival and acute exacerbation

 Sung Woo Moon  ;  Moo Suk Park  ;  Young Sam Kim  ;  Joon Jang  ;  Jae Ho Lee  ;  Choon-Taek Lee  ;  Jin-Haeng Chung  ;  Hyo Sup Shim  ;  Kyung Won Lee  ;  Seung-Seob Kim  ;  Sang Hoon Lee  ;  Ho Il Yoon 
 BMC PULMONARY MEDICINE, Vol.19(1) : 177, 2019 
Journal Title
Issue Date
Acute exacerbation ; Combined pulmonary fibrosis and emphysema (CPFE) ; Idiopathic pulmonary fibrosis ; Mortality ; Non-small cell lung cancer
BACKGROUND: In non-small cell lung cancer (NSCLC) patients, concomitant idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) are independently related to poor survival. CPFE is a condition with features of both pulmonary fibrosis and emphysema. Here, we evaluated the effect of CPFE and IPF alone on the outcomes of NSCLC patients. PATIENTS AND METHODS: We retrospectively evaluated 283 patients with CPFE or IPF who were diagnosed with NSCLC between November 2003 and February 2018 at two tertiary care hospitals in South Korea. Patients were classified into CPFE and IPF groups according to chest computed tomography findings. RESULTS: One-hundred-and-seven patients (37.8%; mean age: 70.1 years; men 97.2%) had CPFE. Compared with IPF patients, CPFE patients had a heavier smoking history; lower diffusing capacity of carbon monoxide (78.0% vs 64.8%, p <  0.001), and lower forced expiratory volume in 1 s. Of all patients with NSCLC, 71.7% overall died during the follow-up period; 71.6% died in the CPFE group and 72.0% in the IPF group. Multivariate logistic regression analysis showed that CPFE (odds ratio [OR]: 2.26, 95% confidence interval [CI]: 1.09-4.69; P = 0.029) was significantly correlated with acute exacerbations (AEs). In a Cox proportional hazards analysis, stage > III NSCLC, higher Eastern Cooperative Oncology Group performance status, and higher gender-age-physiology index score was related to higher mortality. However, CPFE was not related to a higher mortality rate in univariate (hazard ratio [HR]: 1.00; 95% CI: 0.75-1.32, P = 0.972) or multivariate analysis (HR: 0.89; 95% CI: 0.66-1.21, P = 0.466). CONCLUSIONS: AE risk, but not all-cause mortality, was higher in patients with CPFE and NSCLC than in those with IPF and NSCLC. Physicians should be aware of the exaggerated risk of AE in patients with concomitant CPFE and NSCLC.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung-seob(김승섭) ORCID logo https://orcid.org/0000-0001-6071-306X
Kim, Young Sam(김영삼) ORCID logo https://orcid.org/0000-0001-9656-8482
Moon, Sung Woo(문성우) ORCID logo https://orcid.org/0000-0001-9917-9802
Park, Moo Suk(박무석) ORCID logo https://orcid.org/0000-0003-0820-7615
Shim, Hyo Sup(심효섭) ORCID logo https://orcid.org/0000-0002-5718-3624
Lee, Sang Hoon(이상훈) ORCID logo https://orcid.org/0000-0002-7706-5318
Chang, Joon(장준) ORCID logo https://orcid.org/0000-0003-4542-6841
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