The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema

Abstract

Combined pulmonary fibrosis and emphysema (CPFE) is an important risk factor for lung cancer (LC), because most patients with CPFE are smokers. However, the histological characteristics of LC in patients with CPFE (LC‐CPFE) remain unclear. We conducted this study to explore the clinicopathological characteristics of LC‐CPFE. We retrospectively reviewed data from 985 patients who underwent resection for primary LC, and compared the clinicopathological characteristics of patients with LC‐CPFE and non‐CPFE LC. We identified 72 cases of LC‐CPFE, which were significantly associated with squamous cell carcinoma (SqCC) histology (n = 46, P < 0.001) and higher tumor grade (n = 44, P < 0.001), compared to non‐CPFE LC. Most LC‐CPFE lesions were contiguous with fibrotic areas around the tumor (n = 59, 81.9%), and this association was independent of tumor location. Furthermore, dysplastic epithelium was identified in the fibrotic area for 31 (52.5%) LC‐CPFE lesions. Moreover, compared to patients with pulmonary fibrosis alone in the non‐CPFE group (n = 31), patients with CPFE were predominantly male (P = 0.008) and smokers (P < 0.001), with LC‐CPFE predominantly exhibiting SqCC histology (P = 0.010) and being contiguous with the tumor‐associated fibrotic areas (P < 0.001). Multivariate analysis revealed that CPFE was an independent predictor of overall survival (hazard ratio: 1.734; 95% confidence interval: 1.060–2.791; P = 0.028). Our results indicate that LC‐CPFE has a distinct histological phenotype, can arise from the dysplastic epithelium in the fibrotic area around the tumor, and is associated with poor survival outcomes.

Clinical characteristics and outcomes of lung cancer patients with combined pulmonary fibrosis and emphysema: a systematic review and meta-analysis of 13 studies

“…Several previous studies showed lung cancer in patients with CPFE was advanced stage (10,14), while other studies indicated that more lung cancer patients with CPFE were early stage (11)(12)(13)(15)(16)(17)(18)(19)(20)(21)(22). Pulmonary function test was conducted in several studies, and the results have varied (11)(12)(14)(15)(16)(17)(18)(19)(20)(21)(22). CPFE was an independent factor for a poor prognosis in lung cancer patient with CPFE (11,18,21).…”

“…In three previous studies of lung cancer patients with CPFE adenocarcinoma was the most common type of cancer, followed by squamous cell carcinoma (10)(11)(12). However, other studies had shown that squamous cell carcinoma was the most common type of cancer (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Several previous studies showed lung cancer in patients with CPFE was advanced stage (10,14), while other studies indicated that more lung cancer patients with CPFE were early stage (11)(12)(13)(15)(16)(17)(18)(19)(20)(21)(22).…”

“…However, other studies had shown that squamous cell carcinoma was the most common type of cancer (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Several previous studies showed lung cancer in patients with CPFE was advanced stage (10,14), while other studies indicated that more lung cancer patients with CPFE were early stage (11)(12)(13)(15)(16)(17)(18)(19)(20)(21)(22). Pulmonary function test was conducted in several studies, and the results have varied (11)(12)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

“…Pulmonary function test was conducted in several studies, and the results have varied (11)(12)(14)(15)(16)(17)(18)(19)(20)(21)(22). CPFE was an independent factor for a poor prognosis in lung cancer patient with CPFE (11,18,21). It remained unclear why CPFE was an independent prognostic factor for a poor outcome in lung cancer patients (11).…”

“…It remained unclear why CPFE was an independent prognostic factor for a poor outcome in lung cancer patients (11). Four studies clarified risk factors for long-term survival, while which factors were independent risk factors was controversial (11,12,18,21,22). The resected lung cancer patients with CPFE showed quite high postoperative mortality rates and frequent complications and the rate of lung cancer-associated mortality was high, while some studies held different views (11)(12)(14)(15)(16)(18)(19)(20)(21)(22).…”