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A. Yoshizawa
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P1.04 - Poster Session/ Biology, Pathology, and Molecular Testing (ID 233)
- Event: WCLC 2015
- Type: Poster
- Track: Biology, Pathology, and Molecular Testing
- Presentations: 1
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
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P1.04-013 - Clinicopathological Characteristics of Lung Cancer with Combined Pulmonary Fibrosis and Emphysema (ID 1082)
09:30 - 09:30 | Author(s): A. Yoshizawa
- Abstract
Background:
Combined pulmonary fibrosis and emphysema (CPFE) is a clinical syndrome that is diagnosed with computed tomography (CT), sometimes in conjunction with histopathology. Mostly all patients with CPFE are smokers, and thus, they are at high risk of developing lung cancer (LC). The histological and clinical characteristics of coexisting LC and CPFE syndrome remain unclear. Therefore, we conducted a retrospective study to explore the clinicopathological characteristics of LC along with CPFE (LC-CPFE).
Methods:
We retrospectively reviewed the data of 1647 patients who underwent lung resection for pulmonary masses at Shinshu University Hospital between December 1995 and December 2013. After excluding patients without CT images, patients with metastatic tumors, and patients without sufficient clinical and histological information, the remaining patients were divided into four groups based on chest CT findings: LC-CPFE, LC along with pulmonary fibrosis (LC-PF), LC along with emphysema (LC-Emp), and LC in normal lungs (LC-Norm). The clinicopathological characteristics of patients with LC-CPFE were compared to those of the patients in the other groups.
Results:
After excluding patients for the reasons described above, 985 patients were enrolled in this study. Of these 985 patients, there were 72, 28, 84, and 801 cases of LC-CPFE, LC-PF, LC-Emp, and LC-Norm, respectively. Patients with LC-CPFE were all smokers, with a mean Brinkman index of 1158. Compared with the other groups, patients with LC-CPFE were predominantly men (n = 67, 93.0%) and were older (a mean age of 70.5); LC-CPFE was also associated with a larger tumor size (a mean tumor size of 29.5 mm), the presence of multiple tumors (n = 13, 18.0%), higher stage, squamous cell carcinoma-predominant histology (n = 46, 63.9%), and higher tumor grade (n = 45, 62.5%). Patients with LC-CPFE showed a significantly worse outcome than did patients with LC-Emp and LC-Norm, with a 5-year disease-free survival (DFS) rate of 63.5% and a 5-year overall survival (OS) rate of 53.5%. The OS rate of patients with LC-CPFE was worse than that of patients with LC-PF, although the statistical difference was not significant (p = 0.06), whereas the DFS rates between the LC-CPFE group and the LC-PF group were not significantly different (p = 0.664). In the LC-CPFE group, the tumors were mostly found in associated fibrotic areas (n = 56, 77.7%), followed by emphysematous areas (n = 9) and normal lung areas (n = 7). The pattern of the fibrotic area was as follows: 31 unclassified, 19 UIP, and 6 NSIP. In situ carcinomatous lesions were found in fibrotic areas of more than half of the LC-CPFE cases (n = 30, 53.5%).
Conclusion:
This study indicates that LCs in patients with CPFE syndrome developed in heterogeneous tumorigenic backgrounds. However, because patients with LC-CPFE showed significantly poorer outcomes compared with the other groups, CPFE should be considered an important background disease for patients after resection of lung cancer.
