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Gonnelli F, Kaur J, Bonifazi M, Baldwin D, O'Dowd E, Hubbard R. Pulmonary fibrosis and lung cancer: an analysis of the Clinical Practice Research Datalink linked to the National Cancer Registration Dataset. Thorax 2024; 79:982-985. [PMID: 39256044 DOI: 10.1136/thorax-2024-221865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2024]
Abstract
We quantified the proportion of diagnoses of pulmonary fibrosis (PF) among 25 136 people with lung cancer and 250 583 matched controls and compared the natural history of lung cancer in people with and without PF. Diagnoses of PF were more common in people with lung cancer than those without (1.5% vs 0.8%, OR 1.97; 95% CI 1.77 to 2.21). Within people with PF, squamous cell carcinoma was more (22.9% vs 19.1%), and adenocarcinoma was less common (18.0% vs 21.3%). People with PF were less likely to have stage 4 disease at diagnosis (OR 0.43, 95% CI 0.28 to 0.65) but their survival was worse.
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Affiliation(s)
- Francesca Gonnelli
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
| | - Jaspreet Kaur
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
| | - Martina Bonifazi
- Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy
- Interstitial Lung Diseases, Pleural Diseases and Bronchiectasis Unit, Ospedali Riuniti Ancona Umberto I-G.M. Lancisi-G. Salesi, Ancona, Italy
| | - David Baldwin
- Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
- University of Nottingham, Nottingham, UK
| | - Emma O'Dowd
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
- Respiratory Medicine, Nottingham University Hospitals, Nottingham, UK
| | - Richard Hubbard
- Translational Medical Sciences, University of Nottingham, Nottingham, UK
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Drakopanagiotakis F, Krauss E, Michailidou I, Drosos V, Anevlavis S, Günther A, Steiropoulos P. Lung Cancer and Interstitial Lung Diseases. Cancers (Basel) 2024; 16:2837. [PMID: 39199608 PMCID: PMC11352559 DOI: 10.3390/cancers16162837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 08/01/2024] [Accepted: 08/11/2024] [Indexed: 09/01/2024] Open
Abstract
Lung cancer continues to be one of the leading causes of cancer-related death worldwide. There is evidence of a complex interplay between lung cancer and interstitial lung disease (ILD), affecting disease progression, management strategies, and patient outcomes. Both conditions develop as the result of common risk factors such as smoking, environmental exposures, and genetic predispositions. The presence of ILD poses diagnostic and therapeutic challenges in lung cancer management, including difficulties in interpreting radiological findings and increased susceptibility to treatment-related toxicities, such as acute exacerbation of ILD after surgery and pneumonitis after radiation therapy and immunotherapy. Moreover, due to the lack of large, phase III randomized controlled trials, the evidence-based therapeutic options for patients with ILDs and lung cancer remain limited. Antifibrotic treatment may help prevent pulmonary toxicity due to lung cancer treatment, but its effect is still unclear. Emerging diagnostic modalities and biomarkers and optimizing personalized treatment strategies are essential to improve outcomes in this patient population.
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Affiliation(s)
- Fotios Drakopanagiotakis
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.D.); (S.A.)
| | - Ekaterina Krauss
- European IPF Registry & Biobank (eurIPFreg/Bank), 35394 Giessen, Germany; (E.K.); (A.G.)
- Center for Interstitial and Rare Lung Diseases, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35394 Giessen, Germany
| | - Ira Michailidou
- Department of Pneumonology, General Anti-Cancer Oncological Hospital, Agios Savvas, 11522 Athens, Greece;
| | - Vasileios Drosos
- Department of Thoracic and Cardiovascular Surgery, University Hospital Würzburg, 97070 Würzburg, Germany;
| | - Stavros Anevlavis
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.D.); (S.A.)
| | - Andreas Günther
- European IPF Registry & Biobank (eurIPFreg/Bank), 35394 Giessen, Germany; (E.K.); (A.G.)
- Center for Interstitial and Rare Lung Diseases, Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), 35394 Giessen, Germany
- Agaplesion Lung Clinic, 35753 Greifenstein, Germany
- Cardio-Pulmonary Institute (CPI), EXC 2026, Project ID: 390649896, Justus-Liebig University Giessen, 35394 Giessen, Germany
| | - Paschalis Steiropoulos
- Department of Pneumonology, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (F.D.); (S.A.)
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Chen L. Assessing the diagnostic utility of serum tumor markers for lung cancer detection in patients with interstitial pneumonia. Clin Transl Oncol 2024:10.1007/s12094-024-03638-7. [PMID: 39095684 DOI: 10.1007/s12094-024-03638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 07/22/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The prevalence of lung cancer among individuals afflicted with interstitial pneumonia (IP) stands at approximately 20%. The early detection of lung cancer via chest computed tomography (CT) surveillance proves challenging in IP patients. Our investigation sought to identify a potential biomarker capable of providing early indications of the presence of lung tumors in such patients. MATERIALS AND METHODS We examined the attributes of serum tumor markers, imaging characteristics, and histological findings in individuals diagnosed with IP, both with and without concurrent lung cancer. RESULTS 106 patients diagnosed with IP were included in the study, comprising 36 individuals with concurrent lung cancer and 70 patients solely diagnosed with IP. Serum concentrations of CEA and CA12-5 were notably elevated in IP patients with lung cancer, compared to those with IP alone. Logistic regression analyses revealed that, in comparison to IP patients within the first quartile of CEA levels, the relative risk of developing lung cancer associated with IP escalated by 4.0-fold, 3.1-fold, 11.0-fold, and 13.3-fold in the second, third, fourth, and fifth quartiles, respectively. Upon controlling for gender and age, statistical significance in risk was observed solely for the fourth and fifth quartiles. Receiver operating characteristic (ROC) curve analysis conducted in patients diagnosed with ILD-CA identified a CEA cutoff point of 6.9 ng/mL, demonstrating sensitivities of 61.1% and specificities of 78.5%. The area under the curve was calculated as 0.7(95% CI: 0.63-0.81). CONCLUSION The serum levels of CEA were notably elevated in IP patients with concurrent lung cancer in contrast to those who were just suffering from IP. The heightened serum CEA levels correlate with an escalated risk of cancer occurrence among IP patients, suggesting that serum CEA levels could potentially serve as an indicative marker for the presence of cancer in IP patients.
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Affiliation(s)
- Lulu Chen
- People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, 817 Middle Road 602, Taijiang District, Fuzhou, Fujian Province, China.
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Hwang J, Kim H, Kim SM, Yang DS. Preliminary Results of Developing Imaging Complexity Biomarkers for the Incidence of Severe Radiation Pneumonitis Following Radiotherapy in Non-Small Cell Lung Cancer Patients with Underlying Idiopathic Pulmonary Fibrosis. Life (Basel) 2024; 14:897. [PMID: 39063650 PMCID: PMC11277958 DOI: 10.3390/life14070897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) has the potential to cause fatal pulmonary toxicity after radiotherapy and can increase the morbidity and mortality of non-small-cell lung cancer (NSCLC) patients. In this context, we aimed to develop imaging complexity biomarkers to predict the incidence of severe pulmonary toxicity in patients with NSCLC who have underlying IPF and are treated with radiotherapy. Methods: We retrospectively reviewed the medical records of 19 patients with NSCLC who had underlying IPF and were treated with radiotherapy at the Korea University Guro Hospital between March 2018 and December 2022. To quantify the morphometric complexity of the lung parenchyma, box-counting fractal dimensions and lacunarity analyses were performed on pre-radiotherapy simulation chest computed tomography scans. Results: Of the 19 patients, the incidence of grade 3 or higher radiation pneumonitis was observed in 8 (42.1%). After adjusting for age, sex, smoking status, histology, and diffusing capacity of the lung for carbon monoxide, eight patients with a lower fractal dimension showed a significantly higher hazard ratio of 7.755 (1.168-51.51) for grade 3 or higher pneumonitis than those with a higher fractal dimension. Patients with lower lacunarity exhibited significantly lower hazards in all models, both with and without adjustments. The lower-than-median lacunarity group also showed significantly lower incidence curves for all models built in this study. Conclusions: We devised a technique for quantifying morphometric complexity in NSCLC patients with IPF on radiotherapy and discovered lacunarity as a potential imaging biomarker for grade 3 or higher pneumonitis.
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Affiliation(s)
- Jeongeun Hwang
- Department of Medical IT Engineering, Soonchunhyang University, Asan 31538, Chungcheongnam-do, Republic of Korea;
| | - Hakyoung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
| | - Sun Myung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
| | - Dae Sik Yang
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul 08308, Republic of Korea;
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Sampsonas F, Bosgana P, Bravou V, Tzouvelekis A, Dimitrakopoulos FI, Kokkotou E. Interstitial Lung Diseases and Non-Small Cell Lung Cancer: Particularities in Pathogenesis and Expression of Driver Mutations. Genes (Basel) 2024; 15:934. [PMID: 39062713 PMCID: PMC11276289 DOI: 10.3390/genes15070934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/10/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Interstitial lung diseases are a varied group of diseases associated with chronic inflammation and fibrosis. With the emerging and current treatment options, survival rates have vastly improved. Having in mind that the most common type is idiopathic pulmonary fibrosis and that a significant proportion of these patients will develop lung cancer as the disease progresses, prompt diagnosis and personalized treatment of these patients are fundamental. SCOPE AND METHODS The scope of this review is to identify and characterize molecular and pathogenetic pathways that can interconnect Interstitial Lung Diseases and lung cancer, especially driver mutations in patients with NSCLC, and to highlight new and emerging treatment options in that view. RESULTS Common pathogenetic pathways have been identified in sites of chronic inflammation in patients with interstitial lung diseases and lung cancer. Of note, the expression of driver mutations in EGFR, BRAF, and KRAS G12C in patients with NSCLC with concurrent interstitial lung disease is vastly different compared to those patients with NSCLC without Interstitial Lung Disease. CONCLUSIONS NSCLC in patients with Interstitial Lung Disease is a challenging diagnostic and clinical entity, and a personalized medicine approach is fundamental to improving survival and quality of life. Newer anti-fibrotic medications have improved survival in IPF/ILD patients; thus, the incidence of lung cancer is going to vastly increase in the next 5-10 years.
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Affiliation(s)
- Fotios Sampsonas
- Department of Respiratory Medicine, Medical School, University of Patras, 26504 Patras, Greece;
| | - Pinelopi Bosgana
- Department of Pathology, Medical School, University of Patras, 26504 Patras, Greece;
| | - Vasiliki Bravou
- Department of Anatomy, Embryology and Histology, Medical School, University of Patras, 26504 Patras, Greece;
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, Medical School, University of Patras, 26504 Patras, Greece;
| | | | - Eleni Kokkotou
- Oncology Unit, The Third Department of Medicine, Medical School, National and Kapodistrian University of Athens, 15772 Athens, Greece;
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Sung FC, Chen PC, Muo CH, Shen TC, Gerbino AJ. Cancer and pulmonary fibrosis risks in patients with dermatomyositis and polymyositis: A retrospective cohort study. Heliyon 2024; 10:e33883. [PMID: 39071683 PMCID: PMC11283139 DOI: 10.1016/j.heliyon.2024.e33883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 06/04/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024] Open
Abstract
Background This study assessed the risks of developing pulmonary fibrosis and cancer and whether patients are at risk of acquiring subsequent cancer after pulmonary fibrosis development. Methods From the claims data of 22 million insured people, we identified 1461 patients with dermatomyositis (DM) and 1058 with polymyositis (PM) diagnosed in 1996-2016 and 50,380 comparison individuals without pulmonary fibrosis and cancer at baseline, matched by sex and age. Incident pulmonary fibrosis and cancer in each cohort were assessed at the end of 2016. We further followed up individuals with and without pulmonary fibrosis to assess the subsequent development of cancer. Results The cancer incidence was 2.6-fold higher in the DM/PM groups combined than in comparisons (135.3 vs. 52.1 per 10,000 person-years), with an adjusted hazard ratio (aHR) of 3.11 (95 % confidence interval [CI] = 2.71-3.58). The incidence was lower in patients with PM than in those with DM (81.3 vs. 176 per 10,000 person-years), with an aHR of 0.39 (95 % CI = 0.29-0.54). The likelihood of developing pulmonary fibrosis was 92 times higher in the PM/DM groups combined than in comparisons (37.9 vs. 0.41 per 10,000 person-years; aHR 84.0 (95 % CI = 49.5-143). The incidence was 1.44-fold higher in patients with PM than in those with DM (46.1 vs. 32.0 per 10,000 person-years), but the difference was not significant. Further analysis showed that in 2452 patients with myositis without pulmonary fibrosis, 234 (9.5 %) had cancer, whereas no cancer was identified in 67 patients with pulmonary fibrosis (p = 0.019). Conclusion Patients with PM and DM are at great risk of developing cancer and pulmonary fibrosis. Patients who develop pulmonary fibrosis might be at low risk of developing cancer. The complexity of cancer risk interplaying between patients with and without pulmonary fibrosis has clinical relevance and deserves further investigation. Patients who are free of pulmonary fibrosis deserve close monitoring to reduce subsequent cancer risk.
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Affiliation(s)
- Fung-Chang Sung
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, 404, Taiwan
- Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, 413, Taiwan
| | - Pei-Chun Chen
- Department of Public Health, College of Public Health, China Medical University, Taichung, 404, Taiwan
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin, 632, Taiwan
| | - Chih-Hsin Muo
- Management Office for Health Data, China Medical University Hospital, Taichung, 404, Taiwan
| | - Te-Chun Shen
- School of Medicine, College of Medicine, China Medical University, Taichung, 404, Taiwan
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, 404, Taiwan
| | - Anthony J. Gerbino
- Division of Pulmonary Medicine, Virginia Mason Medical Center, Seattle, Wa, 98101, USA
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Peng J, Bie Z, Li Y, Guo R, Li X. Safety and efficacy of CT-guided percutaneous microwave ablation for stage I non-small cell lung cancer in patients with comorbid idiopathic pulmonary fibrosis. Eur Radiol 2024; 34:4708-4715. [PMID: 38114848 DOI: 10.1007/s00330-023-10510-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/24/2023] [Accepted: 11/06/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of microwave ablation (MWA) for stage I non-small cell lung cancer (NSCLC) in patients with idiopathic pulmonary fibrosis (IPF). MATERIALS AND METHODS A retrospective single-center cohort study was conducted in patients with clinical stage I NSCLC who underwent CT-guided MWA from Nov 2016 to Oct 2021. The patients were divided into the IPF group and the non-IPF group. The primary endpoints were 90-day adverse events and hospital length of stay (HLOS). The secondary endpoints included overall survival (OS) and progression-free survival (PFS). RESULTS A total of 107 patients (27 with IPF and 80 without IPF) were finally included for analysis. No procedure-related acute exacerbation of IPF or death occurred post-MWA. The rates of adverse events were similar between the groups (48.6% vs. 47.7%; p = 0.998). The incidence of grade 3 adverse events in the IPF group was higher than that in the non-IPF group without a significant difference (13.5% vs. 4.6%; p = 0.123). Median HLOS was 5 days in both groups without a significant difference (p = 0.078). The 1-year and 3-year OS were 85.2%/51.6% in the IPF group, and 97.5%/86.4% in the non-IPF group. The survival of patients with IPF was significantly poorer than the survival of patients without IPF (p < 0.001). There was no significant difference for PFS (p = 0.271). CONCLUSION MWA was feasible in the treatment of stage I NSCLC in patients with IPF. IPF had an adverse effect on the survival of stage I NSCLC treated with MWA. CLINICAL RELEVANCE STATEMENT CT-guided microwave ablation is a well-tolerated and effective potential alternative treatment for stage I non-small cell lung cancer in patients with idiopathic pulmonary fibrosis. KEY POINTS • Microwave ablation for stage I non-small cell lung cancer was well-tolerated without procedure-related acute exacerbation of idiopathic pulmonary fibrosis and death in patients with idiopathic pulmonary fibrosis. • No differences were observed in the incidence of adverse events between patients with idiopathic pulmonary fibrosis and those without idiopathic pulmonary fibrosis after microwave ablation (48.6% vs. 47.7%; p = 0.998). • The 1-year and 3-year overall survival rates (85.2%/51.6%) in the idiopathic pulmonary fibrosis group were worse than those in the non- idiopathic pulmonary fibrosis group (97.5%/86.4%) (p < 0.001).
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Affiliation(s)
- JinZhao Peng
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100370, China
| | - ZhiXin Bie
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
| | - YuanMing Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
| | - RunQi Guo
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China
| | - XiaoGuang Li
- Department of Minimally Invasive Tumor Therapies Center, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, No. 1 Dongdan Dahua Street, Beijing, 100730, China.
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100370, China.
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Ozaltin B, Chapman R, Arfeen MQU, Fitzpatick N, Hemingway H, Direk K, Jacob J. Delineating excess comorbidities in idiopathic pulmonary fibrosis: an observational study. Respir Res 2024; 25:249. [PMID: 38898447 PMCID: PMC11186192 DOI: 10.1186/s12931-024-02875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Our study examined whether prevalent and incident comorbidities are increased in idiopathic pulmonary fibrosis (IPF) patients when compared to matched chronic obstructive pulmonary disease (COPD) patients and control subjects without IPF or COPD. METHODS IPF and age, gender and smoking matched COPD patients, diagnosed between 01/01/1997 and 01/01/2019 were identified from the Clinical Practice Research Datalink GOLD database multiple registrations cohort at the first date an ICD-10 or read code mentioned IPF/COPD. A control cohort comprised age, gender and pack-year smoking matched subjects without IPF or COPD. Prevalent (prior to IPF/COPD diagnosis) and incident (after IPF/COPD diagnosis) comorbidities were examined. Group differences were estimated using a t-test. Mortality relationships were examined using multivariable Cox proportional hazards adjusted for patient age, gender and smoking status. RESULTS Across 3055 IPF patients, 38% had 3 or more prevalent comorbidities versus 32% of COPD patients and 21% of matched control subjects. Survival time reduced as the number of comorbidities in an individual increased (p < 0.0001). In IPF, prevalent heart failure (Hazard ratio [HR] = 1.62, 95% Confidence Interval [CI]: 1.43-1.84, p < 0.001), chronic kidney disease (HR = 1.27, 95%CI: 1.10-1.47, p = 0.001), cerebrovascular disease (HR = 1.18, 95%CI: 1.02-1.35, p = 0.02), abdominal and peripheral vascular disease (HR = 1.29, 95%CI: 1.09-1.50, p = 0.003) independently associated with reduced survival. Key comorbidities showed increased incidence in IPF (versus COPD) 7-10 years prior to IPF diagnosis. INTERPRETATION The mortality impact of excessive prevalent comorbidities in IPF versus COPD and smoking matched controls suggests that multiorgan mechanisms of injury need elucidation in patients that develop IPF.
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Affiliation(s)
- Burcu Ozaltin
- Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK
| | | | | | | | | | - Kenan Direk
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | - Joseph Jacob
- Satsuma Lab, Centre for Medical Image Computing, UCL, London, UK.
- UCL Respiratory, UCL, London, UK.
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Naqvi M, Hannah J, Lawrence A, Myall K, West A, Chaudhuri N. Antifibrotic therapy in progressive pulmonary fibrosis: a review of recent advances. Expert Rev Respir Med 2024; 18:397-407. [PMID: 39039699 DOI: 10.1080/17476348.2024.2375420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/28/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION Progressive pulmonary fibrosis (PPF) is a manifestation of a heterogenous group of underlying interstitial lung disease (ILD) diagnoses, defined as non-idiopathic pulmonary fibrosis (IPF) progressive fibrotic ILD meeting at least two of the following criteria in the previous 12 months: worsening respiratory symptoms, absolute decline in forced vital capacity (FVC) more than or equal to 5% and/or absolute decline in diffusing capacity for carbon monoxide (DLCO) more than or equal to 10% and/or radiological progression. AREAS COVERED The authors subjectively reviewed a synthesis of literature from PubMed to identify recent advances in the diagnosis and characterisation of PPF, treatment recommendations, and management challenges. This review provides a comprehensive summary of recent advances and highlights future directions for the diagnosis, management, and treatment of PPF. EXPERT OPINION Recent advances in defining the criteria for PPF diagnosis and licensing of treatment are likely to support further characterisation of the PPF patient population and improve our understanding of prevalence. The diagnosis of PPF remains challenging with the need for a specialised ILD multidisciplinary team (MDT) approach. The evidence base supports the use of immunomodulatory therapy to treat inflammatory ILDs and antifibrotic therapy where PPF develops. Treatment needs to be tailored to the specific underlying disease and determined on a case-by-case basis.
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Affiliation(s)
- Marium Naqvi
- Guy's and St Thomas' NHS Trust, Guy's Hospital, London, UK
| | - Jennifer Hannah
- Department of Rheumatology, Kings' College Hospitals NHS Trust, Orpington Hospital, Orpington, UK
| | | | - Katherine Myall
- Department of Respiratory Medicine, King's College London, London, UK
| | - Alex West
- Guy's and St Thomas' NHS Trust, Guy's Hospital, London, UK
| | - Nazia Chaudhuri
- Department of Health and Life Sciences, School of Medicine, Ulster University, Derry-Londonderry, UK
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Miyamoto A, Michimae H, Nakahara Y, Akagawa S, Nakagawa K, Minegishi Y, Ogura T, Hontsu S, Date H, Takahashi K, Homma S, Kishi K. Acute exacerbation predicting poor outcomes in idiopathic interstitial pneumonia and advanced lung cancer patients undergoing cytotoxic chemotherapy. Sci Rep 2024; 14:10162. [PMID: 38702426 PMCID: PMC11068886 DOI: 10.1038/s41598-024-60833-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/28/2024] [Indexed: 05/06/2024] Open
Abstract
Effective treatment for advanced lung cancer and idiopathic interstitial pneumonia (IIP) remains an unmet medical need. The relationship between chemotherapy's effectiveness in advanced lung cancer and the risk of acute exacerbation of IIP is poorly investigated. There is limited evidence that patients who experience an acute exacerbation of IIPs during cytotoxic chemotherapy have poorer outcomes than those who do not. Among 1004 patients with advanced lung cancer and IIPs enrolled in our published multi-centre retrospective study from 110 Japanese institutions, 708 patients (male: female, 645:63; mean age, 70.4) received first-line chemotherapy. The occurrence of chemotherapy-triggered acute exacerbations of IIPs and overall survival (OS) were analysed. The OS between groups of patients with and without the occurrence of acute exacerbation was compared at four landmark time points (30, 60, 90, and 120 days), starting from the first-line chemotherapy, using the landmark method. The incidence of acute exacerbation in patients who received first-line chemotherapy with small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) was more frequent in NSCLC patients than in SCLC (4.2% vs 12.6%; odds ratio [OR]: 3.316; 95% confidence interval [CI] 1.25-8.8). Median survival time was 9.9 months (95% CI 9.2-10.7). Patients who experienced acute exacerbation had significant worse survival outcomes than those who did not at various time points (30 days, hazard ratio [HR]: 5.191, 95% CI 2.889-9.328; 60 days, HR: 2.351, 95% CI 1.104-5.009; 90 days, HR: 2.416, 95% CI 1.232-4.739; and 120 days, HR: 2.521, 95% CI 1.357-4.681). Acute exacerbation during first-line chemotherapy can predict poor survival.Trial Registration number: UMIN000018227.
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Affiliation(s)
- Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Hirofumi Michimae
- School of Pharmacy, Department of Clinical Medicine (Biostatistics), Kitasato University, 5-9-1 Shirokane Minato-ku, Tokyo, 108-8642, Japan
| | - Yasuharu Nakahara
- Department of Respiratory Medicine, National Hospital Organization, Himeji Medical Centre, 68 Hon-machi, Himeji-shi, Hyogo, 670-8520, Japan
| | - Shinobu Akagawa
- Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital, 3-1-1 Takeoka, Kiyose-shi, Tokyo, 204-8585, Japan
| | - Kazuhiko Nakagawa
- Department of Respiratory Medicine, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka, 543-8555, Japan
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School University, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8602, Japan
- Department of Respiratory Medicine, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo, 101-8643, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Centre, 6-16-1 Tomioka-higashi Kanazawa-ku, Yokohama-shi, Kanagawa, 236-0051, Japan
| | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Sakae Homma
- Department of Pulmonary Medicine, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan
- Department of Pulmonary Medicine, Toho University School of Medicine, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan
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11
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Mochizuki A, Nishida H, Kaimori R, Kondo Y, Kadowaki H, Kusaba T, Kawamura K, Osoegawa A, Sugio K, Daa T. Clinical characteristics, proteins, and genes related to interstitial pneumonia-associated squamous cell carcinoma of the lungs. Pathol Res Pract 2024; 257:155292. [PMID: 38657559 DOI: 10.1016/j.prp.2024.155292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/04/2024] [Indexed: 04/26/2024]
Abstract
Squamous cell carcinoma (SCC) is a common histological type of lung carcinoma that is associated with interstitial pneumonia (IP). We hypothesized that identifying specific genetic alterations or molecular markers of SCC with IP may aid the development of novel therapeutic strategies for the same. Therefore, in the present study, we aimed to identify tumorigenic genetic alterations and molecular markers in cases of SCC with IP. We included 28 lung SCC cases (14 cases with IP and 14 cases without IP). We performed immunohistochemistry for STAT3, STAT5, and TLE1, and next-generation sequencing was performed using an iSeq 100 system. The panel used in this study targeted 50 cancer-associated genes. Immunohistochemically, the rate of TLE1 positivity was higher in the SCC without IP group (93 %) than in the SCC with IP group (29 %), while that of STAT5 was higher in the SCC with IP group (79 %) than in the SCC without IP group (14 %). STAT3 expression was high in both the groups (SCC with IP, 64 %; SCC without IP, 71 %). Eighteen genes were mutated in more than six samples, and FBXW7 mutation was mainly observed in the SCC with IP group (p < 0.01). Mechanisms underlying tumorigenesis in SCC with IP included STAT5 activation via inflammation, while that in SCC without IP included squamous TLE1-mediated metaplasia. These findings are based on smoking-induced STAT3 activation; therefore, patients with IP who smoke are more likely to have progressive SCC. We also found that FBXW7 mutations may be associated with SCC with IP and keratinization. ERBB4 and KDR mutations were observed in both with or without IP, and these genes may be tumor-related genes in SCC. These molecular markers may help determine the prognoses of patients with SCC with IP and direct the development of treatment approaches.
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Affiliation(s)
- Akiko Mochizuki
- Departments of Diagnostic Pathology, Oita University, Oita, Japan
| | - Haruto Nishida
- Departments of Diagnostic Pathology, Oita University, Oita, Japan.
| | - Ryo Kaimori
- Departments of Diagnostic Pathology, Oita University, Oita, Japan
| | - Yoshihiko Kondo
- Departments of Diagnostic Pathology, Oita University, Oita, Japan
| | - Hiroko Kadowaki
- Departments of Diagnostic Pathology, Oita University, Oita, Japan
| | - Takahiro Kusaba
- Departments of Diagnostic Pathology, Oita University, Oita, Japan
| | | | | | - Kenji Sugio
- Thoracic and Breast Surgery, Oita University, Oita, Japan
| | - Tsutomu Daa
- Departments of Diagnostic Pathology, Oita University, Oita, Japan
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12
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Brudon A, Legendre M, Mageau A, Bermudez J, Bonniaud P, Bouvry D, Cadranel J, Cazes A, Crestani B, Dégot T, Delestrain C, Diesler R, Epaud R, Philippot Q, Théou-Anton N, Kannengiesser C, Ba I, Debray MP, Fanen P, Manali E, Papiris S, Nathan N, Amselem S, Gondouin A, Guillaumot A, Andréjak C, Jouneau S, Beltramo G, Uzunhan Y, Galodé F, Westeel V, Mehdaoui A, Hirschi S, Leroy S, Marchand-Adam S, Nunes H, Picard C, Prévot G, Reynaud-Gaubert M, De Vuyst P, Wemeau L, Defossez G, Zalcman G, Cottin V, Borie R. High risk of lung cancer in surfactant-related gene variant carriers. Eur Respir J 2024; 63:2301809. [PMID: 38575158 PMCID: PMC11063619 DOI: 10.1183/13993003.01809-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Several rare surfactant-related gene (SRG) variants associated with interstitial lung disease are suspected to be associated with lung cancer, but data are missing. We aimed to study the epidemiology and phenotype of lung cancer in an international cohort of SRG variant carriers. METHODS We conducted a cross-sectional study of all adults with SRG variants in the OrphaLung network and compared lung cancer risk with telomere-related gene (TRG) variant carriers. RESULTS We identified 99 SRG adult variant carriers (SFTPA1 (n=18), SFTPA2 (n=31), SFTPC (n=24), ABCA3 (n=14) and NKX2-1 (n=12)), including 20 (20.2%) with lung cancer (SFTPA1 (n=7), SFTPA2 (n=8), SFTPC (n=3), NKX2-1 (n=2) and ABCA3 (n=0)). Among SRG variant carriers, the odds of lung cancer was associated with age (OR 1.04, 95% CI 1.01-1.08), smoking (OR 20.7, 95% CI 6.60-76.2) and SFTPA1/SFTPA2 variants (OR 3.97, 95% CI 1.39-13.2). Adenocarcinoma was the only histological type reported, with programmed death ligand-1 expression ≥1% in tumour cells in three samples. Cancer staging was localised (I/II) in eight (40%) individuals, locally advanced (III) in two (10%) and metastatic (IV) in 10 (50%). We found no somatic variant eligible for targeted therapy. Seven cancers were surgically removed, 10 received systemic therapy, and three received the best supportive care according to their stage and performance status. The median overall survival was 24 months, with stage I/II cancers showing better survival. We identified 233 TRG variant carriers. The comparative risk (subdistribution hazard ratio) for lung cancer in SRG patients versus TRG patients was 18.1 (95% CI 7.1-44.7). CONCLUSIONS The high risk of lung cancer among SRG variant carriers suggests specific screening and diagnostic and therapeutic challenges. The benefit of regular computed tomography scan follow-up should be evaluated.
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Affiliation(s)
- Alexandre Brudon
- Service d'Oncologie Thoracique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Inserm CIC-EC 1425, Paris, France
- A. Brudon and M. Legendre contributed equally to this work
| | - Marie Legendre
- UF de Génétique Moléculaire, Hôpital Armand Trousseau, AP-HP, Paris, France
- Sorbonne Université, Inserm UMR-S 933, Maladies Génétiques d'Expression Pédiatrique, Paris, France
- A. Brudon and M. Legendre contributed equally to this work
| | - Arthur Mageau
- Département de Médecine Interne, Hôpital Bichat, AP-HP, Paris, France
- Université Paris Cité, Inserm IAME UMR 1137 Team Descid, Paris, France
| | - Julien Bermudez
- Service de Pneumologie, Centre de Compétences de Maladies Pulmonaires Rares et de Transplantation Pulmonaire, CHU Nord, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Philippe Bonniaud
- Department of Respiratory Diseases and Intensive Care, Reference Constitutive Center for Adult Rare Pulmonary Diseases, Dijon-Bourgogne University Hospital, University of Burgundy, Inserm UMR1231, Dijon, France
| | - Diane Bouvry
- Département de Pneumologie, Hôpital Avicenne, AP-HP, Bobigny, France
- Université Paris 13, Inserm UMR U1272, Bobigny, France
| | - Jacques Cadranel
- Service de Pneumologie et Oncologie Thoracique, DMU APPROCHES, Hôpital Tenon, AP-HP, Paris, France
- Sorbonne Université, GRC04 Theranoscan, Paris, France
| | - Aurélie Cazes
- Département d'Anatomie Pathologique, Hôpital Bichat, AP-HP, Paris, France
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
| | - Bruno Crestani
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
- Service de Pneumologie A, Hôpital Bichat, AP-HP, Paris, France
| | - Tristan Dégot
- Centre de Référence pour les Maladies Respiratoires Rares RespiRare, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Céline Delestrain
- Université de Paris Est Créteil, Inserm IMRB, Créteil, France
- Service de Pneumologie, Centre National Coordinateur de Référence des Pathologies Pulmonaires Rares, ERN-LUNG, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Rémi Diesler
- Université Claude Bernard Lyon 1, Lyon, France
- Département de Génétique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
| | - Ralph Epaud
- Centre de Référence pour les Maladies Respiratoires Rares RespiRare, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université de Paris Est Créteil, Inserm IMRB, Créteil, France
| | - Quentin Philippot
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
- Service de Pneumologie A, Hôpital Bichat, AP-HP, Paris, France
| | - Nathalie Théou-Anton
- Université Paris Cité, Paris, France
- Service de Radiologie, Hôpital Bichat, AP-HP, Paris, France
| | - Caroline Kannengiesser
- Département de Génétique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Paris, France
| | - Ibrahima Ba
- Département de Génétique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Paris, France
| | - Marie-Pierre Debray
- Université Paris Cité, Paris, France
- Service de Radiologie, Hôpital Bichat, AP-HP, Paris, France
| | - Pascale Fanen
- Université de Paris Est Créteil, Inserm IMRB, Créteil, France
- Service de Radiologie, Hôpital Bichat, AP-HP, Paris, France
| | - Efrosine Manali
- Département de Pneumologie Pédiatrique, Centre de Référence des Maladies Respiratoires Rares RespiRare, Paris, France
| | - Spyros Papiris
- General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Nadia Nathan
- Sorbonne Université, Inserm UMR-S 933, Maladies Génétiques d'Expression Pédiatrique, Paris, France
- Service de Pneumologie, Centre des Maladies Pulmonaires Rares, Hôpital de Besançon, Besançon, France
| | - Serge Amselem
- UF de Génétique Moléculaire, Hôpital Armand Trousseau, AP-HP, Paris, France
- Sorbonne Université, Inserm UMR-S 933, Maladies Génétiques d'Expression Pédiatrique, Paris, France
| | - Antoine Gondouin
- Service de Pneumologie, Hôpital de Brabois, Vandoeuvre-les-Nancy, France
| | - Anne Guillaumot
- Respiratory and Intensive Care Unit, University Hospital Amiens, Amiens, France
| | - Claire Andréjak
- EA 4294, AGIR, Jules Verne Picardy University, Amiens, France
- Service de Pneumologie, Centre de Référence Maladies Pulmonaires Rares, Hôpital Pontchaillou, CHU Rennes, Inserm UMR1085 IRSET, Université de Rennes 1, EHESP, Rennes, France
| | - Stephane Jouneau
- Pediatrics Department, Pediatric Pulmonology, CHU Bordeaux, Bordeaux, France
| | - Guillaume Beltramo
- Department of Respiratory Diseases and Intensive Care, Reference Constitutive Center for Adult Rare Pulmonary Diseases, Dijon-Bourgogne University Hospital, University of Burgundy, Inserm UMR1231, Dijon, France
| | - Yurdagul Uzunhan
- Département de Pneumologie, Hôpital Avicenne, AP-HP, Bobigny, France
| | - François Galodé
- Pneumonology and Thoracic Oncology Department, Eure-Seine Hospital Center, Évreux, France
| | - Virginie Westeel
- Service de Pneumologie, Centre des Maladies Pulmonaires Rares, Hôpital de Besançon, Besançon, France
| | - Anas Mehdaoui
- Service de pneumologie, FHU Oncoage, Hôpital Pasteur - CHU Nice, Nice, France
| | - Sandrine Hirschi
- Service de Pneumologie, Groupe de Transplantation Pulmonaire, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Sylvie Leroy
- Université Nice Côte d'Azur, Nice, France
- Service de Pneumologie, Hôpital de Tours, Tours, France
| | - Sylvain Marchand-Adam
- Université de Tours, Inserm U1100, Tours, France
- Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Hilario Nunes
- Département de Pneumologie, Hôpital Avicenne, AP-HP, Bobigny, France
- Université Paris 13, Inserm UMR U1272, Bobigny, France
| | - Clément Picard
- Service de Pneumologie, Hôpital Larrey, Toulouse, France
| | | | - Martine Reynaud-Gaubert
- Service de Pneumologie, Centre de Compétences de Maladies Pulmonaires Rares et de Transplantation Pulmonaire, CHU Nord, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Paul De Vuyst
- Service de Pneumologie et Immuno-allergie, Institut Coeur-Poumon, Lille, France
| | | | | | - Gérard Zalcman
- Service d'Oncologie Thoracique, Hôpital Bichat, AP-HP, Institut du Cancer AP-HP Nord, Paris, France
- Université Paris Cité, Inserm CIC-EC 1425, Paris, France
| | - Vincent Cottin
- Service de Pneumologie, Centre National Coordinateur de Référence des Pathologies Pulmonaires Rares, ERN-LUNG, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Lyon, France
| | - Raphael Borie
- Université Paris Cité, Inserm UMR-S 1152 PHERE, Paris, France
- Service de Pneumologie A, Hôpital Bichat, AP-HP, Paris, France
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13
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Otoshi R, Ikeda S, Kaneko T, Sagawa S, Yamada C, Kumagai K, Moriuchi A, Sekine A, Baba T, Ogura T. Treatment Strategies for Non-Small-Cell Lung Cancer with Comorbid Respiratory Disease; Interstitial Pneumonia, Chronic Obstructive Pulmonary Disease, and Tuberculosis. Cancers (Basel) 2024; 16:1734. [PMID: 38730686 PMCID: PMC11083871 DOI: 10.3390/cancers16091734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
Non-small cell lung cancer (NSCLC) patients are often complicated by other respiratory diseases, including interstitial pneumonia (IP), chronic obstructive pulmonary disease (COPD), and pulmonary tuberculosis (TB), and the management of which can be problematic. NSCLC patients with IP sometimes develop fatal acute exacerbation induced by pharmacotherapy, and the establishment of a safe treatment strategy is desirable. For advanced NSCLC with IP, carboplatin plus nanoparticle albumin-bound paclitaxel is a relatively safe and effective first-line treatment option. Although the safety of immune checkpoint inhibitors (ICIs) for these populations remains controversial, ICIs have the potential to provide long-term survival. The severity of COPD is an important prognostic factor in NSCLC patients. Although COPD complications do not necessarily limit treatment options, it is important to select drugs with fewer side effects on the heart and blood vessels as well as the lungs. Active TB is complicated by 2-5% of NSCLC cases during their disease course. Since pharmacotherapy, especially ICIs, reportedly induces the development of TB, the possibility of developing TB should always be kept in mind during NSCLC treatment. To date, there is no coherent review article on NSCLC with these pulmonary complications. This review article summarizes the current evidence and discusses future prospects for treatment strategies for NSCLC patients complicated with IP, severe COPD, and TB.
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Affiliation(s)
| | - Satoshi Ikeda
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, 6-16-1, Tomioka-higashi, Kanazawa-ku, Yokohama 236-0051, Japan; (R.O.); (T.K.); (S.S.); (C.Y.); (K.K.); (A.M.); (A.S.); (T.B.); (T.O.)
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14
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Read J, Reid AT, Thomson C, Plit M, Mejia R, Knight DA, Lize M, El Kasmi K, Grainge CL, Stahl H, Schuliga M. Alveolar epithelial cells of lung fibrosis patients are susceptible to severe virus-induced injury. Clin Sci (Lond) 2024; 138:537-554. [PMID: 38577922 DOI: 10.1042/cs20240220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/06/2024]
Abstract
Patients with pulmonary fibrosis (PF) often experience exacerbations of their disease, characterised by a rapid, severe deterioration in lung function that is associated with high mortality. Whilst the pathobiology of such exacerbations is poorly understood, virus infection is a trigger. The present study investigated virus-induced injury responses of alveolar and bronchial epithelial cells (AECs and BECs, respectively) from patients with PF and age-matched controls (Ctrls). Air-liquid interface (ALI) cultures of AECs, comprising type I and II pneumocytes or BECs were inoculated with influenza A virus (H1N1) at 0.1 multiplicity of infection (MOI). Levels of interleukin-6 (IL-6), IL-36γ and IL-1β were elevated in cultures of AECs from PF patients (PF-AECs, n = 8-11), being markedly higher than Ctrl-AECs (n = 5-6), 48 h post inoculation (pi) (P<0.05); despite no difference in H1N1 RNA copy numbers 24 h pi. Furthermore, the virus-induced inflammatory responses of PF-AECs were greater than BECs (from either PF patients or controls), even though viral loads in the BECs were overall 2- to 3-fold higher than AECs. Baseline levels of the senescence and DNA damage markers, nuclear p21, p16 and H2AXγ were also significantly higher in PF-AECs than Ctrl-AECs and further elevated post-infection. Senescence induction using etoposide augmented virus-induced injuries in AECs (but not viral load), whereas selected senotherapeutics (rapamycin and mitoTEMPO) were protective. The present study provides evidence that senescence increases the susceptibility of AECs from PF patients to severe virus-induced injury and suggests targeting senescence may provide an alternative option to prevent or treat the exacerbations that worsen the underlying disease.
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Affiliation(s)
- Jane Read
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Andrew T Reid
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Claire Thomson
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- Saint Vincent's Hospital, Sydney, NSW, Australia
| | | | - Ross Mejia
- John Hunter Hospital, Newcastle, NSW, Australia
| | - Darryl A Knight
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
- Providence Health Care Research Institute, Vancouver, British Columbia, Canada
| | - Muriel Lize
- Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | | | - Christopher L Grainge
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
- John Hunter Hospital, Newcastle, NSW, Australia
| | - Heiko Stahl
- Boehringer Ingelheim Pharma GmbH & Co. KG, Germany
| | - Michael Schuliga
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, Australia
- Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
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15
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Althobiani MA, Russell AM, Jacob J, Ranjan Y, Folarin AA, Hurst JR, Porter JC. Interstitial lung disease: a review of classification, etiology, epidemiology, clinical diagnosis, pharmacological and non-pharmacological treatment. Front Med (Lausanne) 2024; 11:1296890. [PMID: 38698783 PMCID: PMC11063378 DOI: 10.3389/fmed.2024.1296890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Interstitial lung diseases (ILDs) refer to a heterogeneous and complex group of conditions characterized by inflammation, fibrosis, or both, in the interstitium of the lungs. This results in impaired gas exchange, leading to a worsening of respiratory symptoms and a decline in lung function. While the etiology of some ILDs is unclear, most cases can be traced back to factors such as genetic predispositions, environmental exposures (including allergens, toxins, and air pollution), underlying autoimmune diseases, or the use of certain medications. There has been an increase in research and evidence aimed at identifying etiology, understanding epidemiology, improving clinical diagnosis, and developing both pharmacological and non-pharmacological treatments. This review provides a comprehensive overview of the current state of knowledge in the field of interstitial lung diseases.
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Affiliation(s)
- Malik A. Althobiani
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anne-Marie Russell
- School of Health and Care Professions, University of Exeter, Exeter, United Kingdom
- School of Medicine and Health, University of Birmingham, Birmingham, United Kingdom
| | - Joseph Jacob
- UCL Respiratory, University College London, London, United Kingdom
- Satsuma Lab, Centre for Medical Image Computing, University College London Respiratory, University College London, London, United Kingdom
| | - Yatharth Ranjan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Amos A. Folarin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, London, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
- NIHR Biomedical Research Centre at University College London Hospitals, NHS Foundation Trust, London, United Kingdom
| | - John R. Hurst
- Royal Free Campus, UCL Respiratory, University College London, London, United Kingdom
| | - Joanna C. Porter
- UCL Respiratory, University College London, London, United Kingdom
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16
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Barravecchia I, Lee JM, Manassa J, Magnuson B, Ferris SF, Cavanaugh S, Steele NG, Espinoza CE, Galban CJ, Ramnath N, Frankel TL, Pasca di Magliano M, Galban S. Modeling Molecular Pathogenesis of Idiopathic Pulmonary Fibrosis-Associated Lung Cancer in Mice. Mol Cancer Res 2024; 22:295-307. [PMID: 38015750 PMCID: PMC10906012 DOI: 10.1158/1541-7786.mcr-23-0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/25/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is characterized by progressive, often fatal loss of lung function due to overactive collagen production and tissue scarring. Patients with IPF have a sevenfold-increased risk of developing lung cancer. The COVID-19 pandemic has increased the number of patients with lung diseases, and infection can worsen prognoses for those with chronic lung diseases and disease-associated cancer. Understanding the molecular pathogenesis of IPF-associated lung cancer is imperative for identifying diagnostic biomarkers and targeted therapies that will facilitate prevention of IPF and progression to lung cancer. To understand how IPF-associated fibroblast activation, matrix remodeling, epithelial-to-mesenchymal transition (EMT), and immune modulation influences lung cancer predisposition, we developed a mouse model to recapitulate the molecular pathogenesis of pulmonary fibrosis-associated lung cancer using the bleomycin and Lewis lung carcinoma models. We demonstrate that development of pulmonary fibrosis-associated lung cancer is likely linked to increased abundance of tumor-associated macrophages and a unique gene signature that supports an immune-suppressive microenvironment through secreted factors. Not surprisingly, preexisting fibrosis provides a pre-metastatic niche and results in augmented tumor growth, and tumors associated with bleomycin-induced fibrosis are characterized by a dramatic loss of cytokeratin expression, indicative of EMT. IMPLICATIONS This characterization of tumors associated with lung diseases provides new therapeutic targets that may aid in the development of treatment paradigms for lung cancer patients with preexisting pulmonary diseases.
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Affiliation(s)
- Ivana Barravecchia
- Center for Molecular Imaging, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer M. Lee
- Center for Molecular Imaging, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Jason Manassa
- Center for Molecular Imaging, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Brian Magnuson
- Rogel Cancer Center, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Biostatistics, School of Public Health, The University of Michigan, Ann Arbor, Michigan
| | - Sarah F. Ferris
- Center for Molecular Imaging, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Sophia Cavanaugh
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Nina G. Steele
- Department of Surgery, Henry Ford Pancreatic Cancer Center, Henry Ford Health, Detroit, Michigan
| | - Carlos E. Espinoza
- Department of Surgery, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Craig J. Galban
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Biomedical Engineering, The University of Michigan Medical School and College of Engineering, Ann Arbor, Michigan
| | - Nithya Ramnath
- Division of Hematology and Oncology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Michigan
- Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Timothy L. Frankel
- Rogel Cancer Center, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Surgery, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Marina Pasca di Magliano
- Rogel Cancer Center, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Surgery, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Cell and Developmental Biology, The University of Michigan Medical School, Ann Arbor, Michigan
| | - Stefanie Galban
- Center for Molecular Imaging, The University of Michigan Medical School, Ann Arbor, Michigan
- Department of Radiology, The University of Michigan Medical School, Ann Arbor, Michigan
- Rogel Cancer Center, The University of Michigan Medical School, Ann Arbor, Michigan
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Iftikhar S, Alhaddad SF, Paulsingh CN, Riaz MF, Garg G, Umeano L, Hamid P. The Role of Proton Pump Inhibitors in the Realm of Idiopathic Pulmonary Fibrosis and its Associated Comorbidities: A Systematic Review. Cureus 2024; 16:e55980. [PMID: 38606271 PMCID: PMC11008918 DOI: 10.7759/cureus.55980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/10/2024] [Indexed: 04/13/2024] Open
Abstract
As the global incidence of idiopathic pulmonary fibrosis (IPF) is on the rise, there is a need for better diagnostic criteria, better treatment options, early and appropriate diagnosis, adequate care, and a multidisciplinary approach to the management of patients. This systematic review explores the role of proton pump inhibitors (PPIs) in IPF and answers the question, "Does proton pump inhibitor improve only the prognosis of gastroesophageal associated idiopathic pulmonary fibrosis or for other types of idiopathic pulmonary fibrosis too?" We used PubMed (PMC) and Google Scholar for data collection for this systematic review and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for conducting this review. After in-depth literature screening and quality appraisal, 12 articles were selected for this systematic review. On the one hand, the efficacy of PPI therapy is supported by research such as the CAPACITY and ASCEND trials, a pilot randomized control trial (RCT) investigating the role of omeprazole in IPF and a bidirectional two-sample Mendelian randomization (MR) study, respectively. On the other hand, a systematic review and meta-analysis on antacid and antireflux surgery in IPF negate these results and show no statistical significance. Questions regarding the efficacy of PPI therapy must be dealt with in an adequately powered multicenter and double-blinded randomized control trial. The anti-inflammatory properties of antacids can serve as the cornerstone for future trials. In the following systematic review, antacid, antireflux therapy, omeprazole, and proton pump therapy are synonymous with stomach acid suppression therapy.
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Affiliation(s)
- Sadaf Iftikhar
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sarah F Alhaddad
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Christian N Paulsingh
- Pathology, St. George's University School of Medicine, St. Georges, GRD
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Muhammad Faisal Riaz
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Gourav Garg
- Orthopaedics, Kings Mill Hospital, Sutton in Ashfield, GBR
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Lotanna Umeano
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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18
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Mackintosh JA, Keir G, Troy LK, Holland AE, Grainge C, Chambers DC, Sandford D, Jo HE, Glaspole I, Wilsher M, Goh NSL, Reynolds PN, Chapman S, Mutsaers SE, de Boer S, Webster S, Moodley Y, Corte TJ. Treatment of idiopathic pulmonary fibrosis and progressive pulmonary fibrosis: A position statement from the Thoracic Society of Australia and New Zealand 2023 revision. Respirology 2024; 29:105-135. [PMID: 38211978 PMCID: PMC10952210 DOI: 10.1111/resp.14656] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/11/2023] [Indexed: 01/13/2024]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease leading to significant morbidity and mortality. In 2017 the Thoracic Society of Australia and New Zealand (TSANZ) and Lung Foundation Australia (LFA) published a position statement on the treatment of IPF. Since that time, subsidized anti-fibrotic therapy in the form of pirfenidone and nintedanib is now available in both Australia and New Zealand. More recently, evidence has been published in support of nintedanib for non-IPF progressive pulmonary fibrosis (PPF). Additionally, there have been numerous publications relating to the non-pharmacologic management of IPF and PPF. This 2023 update to the position statement for treatment of IPF summarizes developments since 2017 and reaffirms the importance of a multi-faceted approach to the management of IPF and progressive pulmonary fibrosis.
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Affiliation(s)
- John A. Mackintosh
- Department of Respiratory MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Gregory Keir
- Department of Respiratory MedicinePrincess Alexandra HospitalBrisbaneQueenslandAustralia
| | - Lauren K. Troy
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Anne E. Holland
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of PhysiotherapyThe Alfred HospitalMelbourneVictoriaAustralia
- Department of Respiratory Research@AlfredCentral Clinical School, Monash UniversityMelbourneVictoriaAustralia
| | - Christopher Grainge
- Department of Respiratory MedicineJohn Hunter HospitalNewcastleNew South WalesAustralia
| | - Daniel C. Chambers
- Department of Respiratory MedicineThe Prince Charles HospitalBrisbaneQueenslandAustralia
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
| | - Debra Sandford
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Thoracic MedicineCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Helen E. Jo
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
| | - Ian Glaspole
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Respiratory MedicineThe Alfred HospitalMelbourneVictoriaAustralia
| | - Margaret Wilsher
- Department of Respiratory MedicineTe Toka Tumai AucklandAucklandNew Zealand
| | - Nicole S. L. Goh
- Department of Respiratory MedicineAustin HospitalMelbourneVictoriaAustralia
- Institute for Breathing and SleepMelbourneVictoriaAustralia
- University of MelbourneMelbourneVictoriaAustralia
| | - Paul N. Reynolds
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Thoracic MedicineCentral Adelaide Local Health NetworkAdelaideSouth AustraliaAustralia
- University of AdelaideAdelaideSouth AustraliaAustralia
| | - Sally Chapman
- Institute for Respiratory Health, University of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Steven E. Mutsaers
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Sally de Boer
- Department of Respiratory MedicineTe Toka Tumai AucklandAucklandNew Zealand
| | - Susanne Webster
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Yuben Moodley
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Institute for Respiratory Health, University of Western AustraliaNedlandsWestern AustraliaAustralia
- Department of Respiratory MedicineFiona Stanley HospitalMurdochWestern AustraliaAustralia
| | - Tamera J. Corte
- Centre of Research Excellence in Pulmonary FibrosisCamperdownNew South WalesAustralia
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- University of SydneySydneyNew South WalesAustralia
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19
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Núñez ER, Zhang S, Glickman ME, Qian SX, Boudreau JH, Lindenauer PK, Slatore CG, Miller DR, Caverly TJ, Wiener RS. What Goes into Patient Selection for Lung Cancer Screening? Factors Associated with Clinician Judgments of Suitability for Screening. Am J Respir Crit Care Med 2024; 209:197-205. [PMID: 37819144 PMCID: PMC10806423 DOI: 10.1164/rccm.202301-0155oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
Rationale: Achieving the net benefit of lung cancer screening (LCS) depends on optimizing patient selection. Objective: To identify factors associated with clinician assessments that a patient was unlikely to benefit from LCS ("LCS-inappropriate") because of comorbidities or limited life expectancy. Methods: Retrospective analysis of patients assessed for LCS at 30 Veterans Health Administration facilities from January 1, 2015 to February 1, 2021. We conducted hierarchical mixed-effects logistic regression analyses to determine factors associated with clinicians' designations of LCS inappropriateness (primary outcome), accounting for 3-year predicted probability (i.e., competing risk) of non-lung cancer death. Measurements and Main Results: Among 38,487 LCS-eligible patients, 1,671 (4.3%) were deemed LCS-inappropriate by clinicians, whereas 4,383 (11.4%) had an estimated 3-year competing risk of non-lung cancer death greater than 20%. Patients with higher competing risks of non-lung cancer death were more likely to be deemed LCS-inappropriate (odds ratio [OR], 2.66; 95% confidence interval [CI], 2.32-3.05). Older patients (ages 75-80; OR, 1.45; 95% CI, 1.18-1.78) and those with interstitial lung disease (OR, 1.98; 95% CI, 1.51-2.59) were more likely to be deemed LCS-inappropriate than would be explained by competing risk of non-lung cancer death, whereas patients currently smoking (OR, 0.65; 95% CI, 0.58-0.73) were less likely to be deemed LCS-inappropriate, suggesting that clinicians over- or underweighted these factors. The probability of being deemed LCS-inappropriate varied from 0.4% to 74%, depending on the clinician making the assessment (median OR, 3.07; 95% CI, 2.89-3.25). Conclusion: Concerningly, the likelihood that a patient is deemed LCS-inappropriate is more strongly associated with the clinician making the assessment than with patient characteristics. Patient selection may be optimized by providing decision support to help clinicians assess net LCS benefit.
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Affiliation(s)
- Eduardo R. Núñez
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts
| | - Sanqian Zhang
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Mark E. Glickman
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Shirley X. Qian
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Jacqueline H. Boudreau
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
| | - Peter K. Lindenauer
- Department of Healthcare Delivery and Population Sciences, Chan Medical School-Baystate, University of Massachusetts, Springfield, Massachusetts
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland Oregon
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland, Oregon
| | - Donald R. Miller
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- Zuckerberg College of Health Sciences, University of Massachusetts, Lowell, Massachusetts
| | - Tanner J. Caverly
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
- VA Ann Arbor Healthcare System, Ann Arbor, Michigan; and
- School of Medicine, University of Michigan, Ann Arbor, Michigan
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston and Bedford Healthcare Systems, Boston, Massachusetts
- VA Bedford Healthcare System, Bedford, Massachusetts
- The Pulmonary Center, School of Medicine, Boston University, Boston, Massachusetts
- National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC
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20
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Hanibuchi M, Ogino H, Sato S, Nishioka Y. Current pharmacotherapies for advanced lung cancer with pre-existing interstitial lung disease : A literature review and future perspectives. THE JOURNAL OF MEDICAL INVESTIGATION 2024; 71:9-22. [PMID: 38735730 DOI: 10.2152/jmi.71.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Patients with interstitial lung disease (ILD), especially those with idiopathic pulmonary fibrosis, are at increased risk of developing lung cancer (LC). Pharmacotherapy for advanced LC has dramatically progressed in recent years;however, management of LC with pre-existing ILD (LC-ILD) is challenging due to serious concerns about the risk of acute exacerbation of ILD (AE-ILD). As patients with LC-ILD have been excluded from most prospective clinical trials of advanced LC, optimal pharmacotherapy remains to be elucidated. Although the antitumor activity of first-line platinum-based cytotoxic chemotherapy appears to be similar in advanced LC patients with or without ILD, its impact on the survival of patients with LC-ILD is limited. Immune checkpoint inhibitors may hold promise for long-term survival, but many challenges remain, including safety and appropriate patient selection. Further understanding the predictive factors for AE-ILD after receiving pharmacotherapy in LC-ILD may lead to appropriate patient selection and lower treatment risk. The aim of this review was to summarize the current evidence related to pharmacotherapy for advanced LC-ILD and discuss emerging areas of research. J. Med. Invest. 71 : 9-22, February, 2024.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Community Medicine for Respirology, Hematology, and Metabolism, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Hirokazu Ogino
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Seidai Sato
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Yasuhiko Nishioka
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
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21
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Zhang W, Dong J. Suppressing epithelial-mesenchymal-transition blue light therapy for reducing macrophage-mediated cancerous pulmonary fibrosis: An in-vitro study. JOURNAL OF BIOPHOTONICS 2023; 16:e202300253. [PMID: 37589213 DOI: 10.1002/jbio.202300253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/18/2023]
Abstract
Lung cancer is the leading killer among all types of cancer globally. As a key factor, epithelial-mesenchymal transition (EMT) plays a crucial role in pathological fibrosis and lung cancer metastasis. This study endeavors to investigate the effect of blue light at specific wavelengths of 405 nm and 415 nm (54 J/cm2 ) on EMT induced by TGF-β1 in A549 cells. The results revealed that the blue light irradiation reduced the morphological characteristics of EMT in the A549 cells, and cell-to-cell connections were weakened significantly. Molecular analysis showed upregulation of epithelial marker E-cadherin and downregulation of EMT marker vimentin. Additionally, exposure to blue light irradiation at 405 nm and 415 nm significantly decelerated the ability of invasion and migration. Moreover, cell viability was also investigated. Based on these findings, blue light can serve as a useful therapeutic option for inhibiting EMT in cases of lung cancer and fibrotic lung disease.
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Affiliation(s)
- Wenjun Zhang
- School of Biomedical Engineering (Suzhou), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jianfei Dong
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
- School of Future Science and Engineering, Soochow University, Suzhou, China
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22
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Kim H, Hwang J, Kim SM, Choi J, Yang DS. Risk factor analysis of the development of severe radiation pneumonitis in patients with non-small cell lung cancer treated with curative radiotherapy, with focus on underlying pulmonary disease. BMC Cancer 2023; 23:992. [PMID: 37848850 PMCID: PMC10583362 DOI: 10.1186/s12885-023-11520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND We aim to identify the multifaceted risk factors that can affect the development of severe radiation pneumonitis (RP) in patients with non-small cell lung cancer (NSCLC) treated with curative high-dose radiotherapy with or without concurrent chemotherapy. METHODS We retrospectively reviewed the medical records of 175 patients with stage-I-III NSCLC treated with curative thoracic X-ray radiotherapy at the Korea University Guro Hospital between June 2019 and June 2022. Treatment-related complications were evaluated using the Common Terminology Criteria for Adverse Events (version 4.03). RESULTS The median follow-up duration was 15 months (range: 3-47 months). Idiopathic pulmonary fibrosis (IPF) as an underlying lung disease (P < 0.001) and clinical stage, regarded as the concurrent use of chemotherapy (P = 0.009), were associated with a high rate of severe RP. In multivariate analyses adjusting confounding variables, the presence of IPF as an underlying disease was significantly associated with severe RP (odds ratio [95% confidence interval] = 48.4 [9.09-347]; P < 0.001). In a subgroup analysis of stage-I-II NSCLC, the incidence of severe RP in the control, chronic obstructive pulmonary disease (COPD), and IPF groups was 3.2%, 4.3%, and 42.9%, respectively (P < 0.001). The incidence of severe RP was 15.2%, 10.7%, and 75.0% in the control, COPD, and IPF groups, respectively (P < 0.001) in the stage-III NSCLC group. CONCLUSIONS This study revealed that IPF as an underlying lung disease and the concurrent use of chemotherapy are associated with a high rate of severe RP. In contrast, COPD did not increase the risk of pulmonary toxicity after receiving curative high-dose radiotherapy.
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Affiliation(s)
- Hakyoung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
| | - Jeongeun Hwang
- Department of Medical IT Engineering, College of Medical Sciences, Soonchunhyang University, Chungcheongnam-Do, Republic of Korea
| | - Sun Myung Kim
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea
| | - Juwhan Choi
- Department of Internal Medicine, Korea University Guro Hospital, Division of Pulmonary, Allergy, and Critical Care Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dae Sik Yang
- Departments of Radiation Oncology, Korea University Guro Hospital, Korea University College of Medicine, 148, Gurodong-Ro, Guro-Gu, Seoul, 08308, Republic of Korea.
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23
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Sonaglioni A, Caminati A, Elia D, Trevisan R, Zompatori M, Grasso E, Lombardo M, Harari S. Comparison of clinical scoring to predict mortality risk in mild-to-moderate idiopathic pulmonary fibrosis. Minerva Med 2023; 114:608-619. [PMID: 37204783 DOI: 10.23736/s0026-4806.23.08585-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND During the last decade, a number of clinical scores, such as Gender-Age-Physiology (GAP) Index, TORVAN Score and Charlson Comorbidity Index (CCI), have been separately used to measure comorbidity burden in idiopathic pulmonary fibrosis (IPF). However, no previous study compared the prognostic value of these scores to assess mortality risk stratification in IPF patients with mild-to-moderate disease. METHODS All consecutive patients with mild-to-moderate IPF who underwent high-resolution computed tomography, spirometry, transthoracic echocardiography and carotid ultrasonography at our Institution, between January 2016 and December 2018, were retrospectively analyzed. GAP Index, TORVAN Score and CCI were calculated in all patients. Primary endpoint was all-cause mortality, whereas secondary endpoint was the composite of all-cause mortality and rehospitalizations for all-causes, over medium-term follow-up. RESULTS Seventy IPF patients (70.2±7.4 yrs, 74.3% males) were examined. At baseline, GAP Index, TORVAN Score and CCI were 3.4±1.1, 14.7±4.1 and 5.3±2.4, respectively. A strong correlation between coronary artery calcification (CAC) and common carotid artery (CCA) intima-media thickness (IMT) (r=0.88), CCI and CAC (r=0.80), CCI and CCA-IMT (r=0.81), was demonstrated in the study group. Follow-up period was 3.5±1.2 years. During follow-up, 19 patients died and 32 rehospitalizations were detected. CCI (HR 2.39, 95% CI: 1.31-4.35) and heart rate (HR 1.10, 95% CI: 1.04-1.17) were independently associated with primary endpoint. CCI (HR 1.54, 95% CI: 1.15-2.06) predicted secondary endpoint, also. A CCI ≥6 was the optimal cut-off for predicting both outcomes. CONCLUSIONS Due to the increased atherosclerotic and comorbidity burden, IPF patients with CCI ≥6 at an early-stage disease have poor outcome over medium-term follow-up.
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Affiliation(s)
| | - Antonella Caminati
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy -
| | - Davide Elia
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy
| | | | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Sergio Harari
- Semi-Intensive Care Unit, Division of Pneumology, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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24
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Aoki A, Hara Y, Fujii H, Murohashi K, Nagasawa R, Tagami Y, Enomoto T, Matsumoto Y, Masuda M, Watanabe K, Horita N, Kobayashi N, Kudo M, Ogura T, Kaneko T. The clinical impact of comorbidities among patients with idiopathic pulmonary fibrosis undergoing anti-fibrotic treatment: A multicenter retrospective observational study. PLoS One 2023; 18:e0291489. [PMID: 37725604 PMCID: PMC10508598 DOI: 10.1371/journal.pone.0291489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Among patients with idiopathic pulmonary fibrosis (IPF), few studies have investigated the clinical impact of anti-fibrotic treatment (AFT) with and without comorbidities. The aim of the study was to determine whether Charlson Comorbidity Index score (CCIS) can predict the efficacy of AFT in patients with IPF. METHODS We retrospectively assessed data extracted from the medical records of IPF patients who received anti-fibrotic agents between 2009 and 2019. The collected data included age, sex, CCIS, pulmonary function test, high-resolution computed tomography (HRCT) pattern, gender/age/physiology (GAP) score, and 3-year IPF-related events defined as the first acute exacerbation or death within 3 years after starting AFT. RESULTS We assessed 130 patients (median age, 74 years) who received nintedanib (n = 70) or pirfenidone (n = 60). Median duration of AFT was 425 days. Patients were categorized into high (≥ 3 points) and low (≤ 2 points) CCIS groups. There was no significant difference between the groups in terms of age, sex, duration of AFT, GAP score, or incidence of usual interstitial pneumonia pattern on HRCT except percentage predicted diffusion capacity of lung for carbon monoxide. Also, significant difference was not seen between the groups for 3-year IPF-related events (P = 0.75). Especially, in the low CCIS group but not the high CCIS group, the longer duration of AFT had better disease outcome. CONCLUSION In the present study, we could not show any relation between CCIS and IPF disease outcomes in patients undergoing AFT, though the longer duration of AFT might be beneficial for IPF outcomes among patients with low CCIS.
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Affiliation(s)
- Ayako Aoki
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yu Hara
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroaki Fujii
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- Department of Pulmonology, Yokohama Minami Kyousai Hospital, Yokohama, Japan
| | - Kota Murohashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Ryo Nagasawa
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Yoichi Tagami
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Tatsuji Enomoto
- Department of Respiratory Medicine, Ofuna Chuo Hospital, Kamakura, Japan
| | - Yutaka Matsumoto
- Department of Respiratory Medicine, Yamato Municipal Hospital, Yamato, Japan
| | - Makoto Masuda
- Department of Respiratory Medicine, Ofuna Chuo Hospital, Kamakura, Japan
- Department of Respiratory Medicine, Fujisawa City Hospital, Fujisawa, Japan
| | - Keisuke Watanabe
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuyuki Horita
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Nobuaki Kobayashi
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Makoto Kudo
- Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Takeshi Kaneko
- Department of Pulmonology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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25
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Axtell AL, David EA, Block MI, Parsons N, Habib R, Muniappan A. Association Between Interstitial Lung Disease and Outcomes After Lung Cancer Resection. Ann Thorac Surg 2023; 116:533-541. [PMID: 37271447 DOI: 10.1016/j.athoracsur.2023.04.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/08/2023] [Accepted: 04/04/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Prior studies have noted that patients with interstitial lung disease (ILD) possess an increased incidence of lung cancer and risk of postoperative respiratory failure and death. We sought to understand the impact of ILD on national-scale outcomes of lung resection. METHODS A retrospective cohort analysis using The Society of Thoracic Surgeons General Thoracic Surgery Database was conducted of patients who underwent a pulmonary resection for non-small cell lung cancer between 2009 and 2019. Baseline characteristics and postoperative outcomes were compared between patients with and without ILD (defined as interstitial fibrosis based on clinical, radiographic, or pathologic evidence). Multivariable logistic regression models identified risk factors associated with postoperative mortality, acute respiratory distress syndrome, and composite morbidity and mortality. RESULTS ILD was documented in 1.5% (1873 of 128,723) of patients who underwent a pulmonary resection for non-small cell lung cancer. Patients with ILD were more likely to smoke (90% vs 85%, P < .001), have pulmonary hypertension (6% vs 1.7%, P < .001), impaired diffusing capacity of lung for carbon monoxide (diffusing capacity of lung for carbon monoxide 40%-75%: 64% vs 51%; diffusing capacity of lung for carbon monoxide <40%: 11% vs 4%, P < .001), and undergo more sublobar resections (34% vs 23%, P < .001) compared with patients without ILD. Patients with ILD had increased postoperative mortality (5.1% vs 1.2%, P < .001), acute respiratory distress syndrome (1.9% vs 0.5%, P < .001), and composite morbidity and mortality (13.2% vs 7.4%, P < .001). ILD remained a strong predictor of mortality (odds ratio, 3.94; 95% CI, 3.09-5.01; P < .001), even when adjusted for patient comorbidities, pulmonary function, extent of resection, and center volume effects. CONCLUSIONS ILD is a risk factor for operative mortality and morbidity after lung cancer resection, even in patients with normal pulmonary function.
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Affiliation(s)
- Andrea L Axtell
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth A David
- Section of Thoracic Surgery, University of Colorado Hospital, Aurora, Colorado
| | - Mark I Block
- Division of Thoracic Surgery, Memorial Healthcare System, Hollywood, Florida
| | - Niharika Parsons
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Robert Habib
- The Society of Thoracic Surgeons Research Center, Chicago, Illinois
| | - Ashok Muniappan
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
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Platenburg MGJP, van Moorsel CHM, Wiertz IA, van der Vis JJ, Vorselaars ADM, Veltkamp M, Grutters JC. Improved Survival of IPF patients Treated With Antifibrotic Drugs Compared With Untreated Patients. Lung 2023; 201:335-343. [PMID: 37341844 DOI: 10.1007/s00408-023-00628-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/09/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Pirfenidone and nintedanib unequivocally inhibit FVC decline, but have been inconsistently linked to reduced mortality in phase III studies. On the contrary, real-world data show a survival benefit of antifibrotic drugs. However, it is unknown what this benefit is across different Gender, Age, and Physiology (GAP) stages. RESEARCH QUESTIONS Is there a difference in transplant-free (TPF) survival of IPF patients receiving antifibrotic drugs (IPFAF) compared with an untreated cohort (IPFnon-AF)? Is this different for patients with GAP stage I, II, or III. METHODS This is a single-center observational cohort study using prospectively included patients diagnosed with IPF between 2008-2018. Primary outcomes were TPF survival difference and 1-, 2-, and 3-year cumulative mortality for IPFAF and IPFnon-AF. This was repeated after stratification for GAP stage. RESULTS In total, 457 patients were included. The median transplant-free survival was 3.4 years in IPFAF (n = 313) and 2.2 years in IPFnon-AF (n = 144, p = 0.005). For GAP stage II, a median survival of 3.1 and 1.7 years was noted for IPFAF (n = 143) and IPFnon-AF (n = 59, p < 0.001), respectively. A significantly lower 1-, 2-, and 3- year cumulative mortality was found for IPFAF with GAP stage II (1 yr: 7.0% vs 35.6%, 2 yr: 26.6% vs 55.9%, and 3 yr: 46.9% vs 69.5%). The 1-year cumulative mortality of IPFAF with GAP III was also significantly lower (19.0% vs 65.0%). CONCLUSION This large real-world study showed a survival benefit in IPFAF compared with IPFnon-AF. This especially holds true for patients with GAP stage II and III.
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Affiliation(s)
- Mark G J P Platenburg
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands.
| | - Coline H M van Moorsel
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo A Wiertz
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands
| | - Joanne J van der Vis
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands
- Department of Clinical Chemistry, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Adriane D M Vorselaars
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel Veltkamp
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan C Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, 3435CM, The Netherlands
- Division of Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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Zheng H, Nie D, Huang X. Association between idiopathic pulmonary fibrosis and risk of different pathological types of lung cancer: a Mendelian randomization study. J Cancer Res Clin Oncol 2023; 149:7751-7757. [PMID: 37009919 DOI: 10.1007/s00432-023-04727-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/28/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Many epidemiological studies have shown that idiopathic pulmonary fibrosis (IPF) is a risk factor for lung cancer (LC), but these studies do not provide direct evidence of a causal association between the two diseases. We investigated the causal association between IPF and different pathological types of LC based on the Mendelian randomization (MR) study. METHODS The genome-wide association study (GWAS) data of IPF and LC were obtained from the latest published articles, and instrumental variables (IVs) for analysis were obtained after screening and eliminating the confounders. MR Analysis was carried out with the help of random effects inverse variance weighting (re-IVW), MR-egger, and weighted median method, and a comprehensive sensitivity test was conducted. RESULTS The results of re-IVW analysis showed that IPF may increase the risk of lung squamous cell carcinoma (LUSC) (OR = 1.045, 95% CI 1.011 to 1.080, P = 0.008). In addition, no causal relationship was found between IPF and overall LC (OR = 0.977, 95% CI 0.933 to 1.023, P = 0.32), lung adenocarcinoma (LUAD) (OR = 0.967, 95% CI 0.903 to 1.036, P = 0.345) and small cell lung carcinoma (SCLC) (OR = 1.081, 95% CI 0.992 to 1.177, P = 0.074). A comprehensive sensitivity analysis ensured the reliability of the study. CONCLUSION In conclusion, from the perspective of genetic association, we found that IPF is an independent risk factor for LUSC and may increase the risk of LUSC, but no such causal relationship was found in LUAD and SCLC.
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Affiliation(s)
- Hao Zheng
- First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Duorui Nie
- Graduate School, Hunan University of Chinese Medicine, Changsha, China
- College of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Xuewu Huang
- Cancer Center, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.
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Fujita Y, Fujimoto S, Miyamoto A, Kaneko R, Kadota T, Watanabe N, Kizawa R, Kawamoto H, Watanabe J, Utsumi H, Wakui H, Minagawa S, Araya J, Ohtsuka T, Ochiya T, Kuwano K. Fibroblast-derived Extracellular Vesicles Induce Lung Cancer Progression in the Idiopathic Pulmonary Fibrosis Microenvironment. Am J Respir Cell Mol Biol 2023; 69:34-44. [PMID: 36848313 DOI: 10.1165/rcmb.2022-0253oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 02/24/2023] [Indexed: 03/01/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive aging-related lung disease associated with increased lung cancer risk. Although previous studies have shown that IPF worsens the survival of patients with lung cancer, whether IPF independently affects cancer malignancy and prognosis remains inconclusive. Extracellular vesicles (EVs) have recently emerged as active carriers of molecular biomarkers and mediators of intercellular communication in lung homeostasis and pathogenesis. EV cargo-mediated fibroblast-tumor cell communication might participate in the development and progression of lung cancer by modulating various signaling pathways. In this study, we examined the impact of lung fibroblast (LF)-derived EVs on non-small cell lung cancer (NSCLC) malignancy in the IPF microenvironment. Here, we showed that LFs derived from patients with IPF have phenotypes of myofibroblast differentiation and cellular senescence. Furthermore, we found that IPF LF-derived EVs have markedly altered microRNA compositions and exert proproliferative functions on NSCLC cells. Mechanistically, the phenotype was attributed mainly to the enrichment of miR-19a in IPF LF-derived EVs. As a downstream signaling pathway, mir-19a in IPF LF-derived EVs regulates ZMYND11-mediated c-Myc activation in NSCLC, potentially contributing to the poor prognosis of patients with NSCLC with IPF. Our discoveries provide novel mechanistic insights for understanding lung cancer progression in the IPF microenvironment. Accordingly, blocking the secretion of IPF LF-derived EV miR-19a and their signaling pathways is a potential therapeutic strategy for managing IPF and lung cancer progression.
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Affiliation(s)
- Yu Fujita
- Division of Respiratory Diseases, Department of Internal Medicine
- Department of Translational Research for Exosomes, and
| | - Shota Fujimoto
- Division of Respiratory Diseases, Department of Internal Medicine
| | - Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan; and
| | - Reika Kaneko
- Department of Translational Research for Exosomes, and
| | - Tsukasa Kadota
- Division of Respiratory Diseases, Department of Internal Medicine
| | - Naoaki Watanabe
- Division of Respiratory Diseases, Department of Internal Medicine
| | - Ryusuke Kizawa
- Division of Respiratory Diseases, Department of Internal Medicine
- Department of Translational Research for Exosomes, and
| | | | - Junko Watanabe
- Division of Respiratory Diseases, Department of Internal Medicine
| | - Hirofumi Utsumi
- Division of Respiratory Diseases, Department of Internal Medicine
| | - Hiroshi Wakui
- Division of Respiratory Diseases, Department of Internal Medicine
| | | | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine
| | - Takashi Ohtsuka
- Division of Thoracic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Takahiro Ochiya
- Department of Molecular and Cellular Medicine, Institute of Medical Science, Tokyo Medical University, Tokyo, Japan
| | - Kazuyoshi Kuwano
- Division of Respiratory Diseases, Department of Internal Medicine
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Isono T, Iwahori K, Yanagawa M, Yamamoto Y, Tone M, Haruna M, Hirata M, Fukui E, Kimura T, Kanou T, Ose N, Funaki S, Takeda Y, Morii E, Kumanogoh A, Shintani Y, Wada H. T cell immunity in interstitial lung disease with non-small cell lung cancer patients. Lung Cancer 2023; 182:107278. [PMID: 37321075 DOI: 10.1016/j.lungcan.2023.107278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/01/2023] [Accepted: 06/06/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Limited treatment options are available for non-small cell lung cancer (NSCLC) patients with interstitial lung disease (ILD). The rationale for immunotherapy and its adverse events for NSCLC with ILD remains unclear. In this study, we examined T cell profiles and functions in the lung tissues of NSCLC patients with or without ILD to provide evidence for the potential mechanism of immune checkpoint inhibitor (ICI)-related pneumonitis in NSCLC patients with ILD. MATERIAL AND METHODS We investigated T cell immunity in the lung tissues of NSCLC patients with ILD to support the application of immunotherapy for these patients. We analyzed T cell profiles and functions in surgically resected lung tissues from NSCLC patients with and without ILD. The T cell profiles of infiltrating cells in lung tissues were analyzed by flow cytometry. T cell functions were measured based on cytokine production by T cells stimulated with phorbol 12-myristate 13-acetate and ionomycin. RESULTS The percentages of CD4+ T cells expressing immune checkpoint molecules (Tim-3, ICOS, and 4-1BB), CD103+CD8+ T cells, and regulatory T (Treg) cells were higher in NSCLC patients with than in those without ILD. A functional analysis of T cells in lung tissues indicated that CD103+CD8+ T cells positively correlated with IFNγ production, whereas Treg cells negatively correlated with IFNγ and TNFα production. Cytokine production by CD4+ and CD8+ T cells did not significantly differ between NSCLC patients with and without ILD, except for TNFα production by CD4+ T cells being lower in the former than in the latter. CONCLUSION In NSCLC patients with ILD stable for surgery, T cells were active participants and balanced in part by Treg cells in lung tissues, suggesting the potential development of ICI-related pneumonitis in NSCLC patients with ILD.
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Affiliation(s)
- Tomomi Isono
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kota Iwahori
- Department of Clinical Research in Tumor Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Masahiro Yanagawa
- Department of Radiology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoko Yamamoto
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Mari Tone
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Miya Haruna
- Department of Clinical Research in Tumor Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan; Biopharmaceutical Research Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Michinari Hirata
- Department of Clinical Research in Tumor Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan; Biopharmaceutical Research Division, Shionogi & Co., Ltd., Osaka, Japan
| | - Eriko Fukui
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Toru Kimura
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takashi Kanou
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Naoko Ose
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Soichiro Funaki
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshito Takeda
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Eiichi Morii
- Department of Pathology, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Immunopathology, World Premier International Research Center Initiative (WPI), Immunology Frontier Research Center (IFReC), Osaka University, Osaka, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Osaka, Japan; Center for Infectious Diseases for Education and Research (CiDER), Osaka University, Osaka, Japan; Japan Agency for Medical Research and Development - Core Research for Evolutional Science and Technology (AMED-CREST), Osaka University, Osaka, Japan; Center for Advanced Modalities and DDS (CAMaD), Osaka University, Osaka, Japan
| | - Yasushi Shintani
- Department of Thoracic Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hisashi Wada
- Department of Clinical Research in Tumor Immunology, Graduate School of Medicine, Osaka University, Osaka, Japan
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Tomassetti S, Ravaglia C, Piciucchi S, Ryu J, Wells A, Donati L, Dubini A, Klersy C, Luzzi V, Gori L, Rosi E, Lavorini F, Poletti V. Historical eye on IPF: a cohort study redefining the mortality scenario. Front Med (Lausanne) 2023; 10:1151922. [PMID: 37332746 PMCID: PMC10273674 DOI: 10.3389/fmed.2023.1151922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/26/2023] [Indexed: 06/20/2023] Open
Abstract
Rationale Therapies that slow idiopathic pulmonary fibrosis (IPF) progression are now available and recent studies suggest that the use of antifibrotic therapy may reduce IPF mortality. Objectives The aim of the study was to evaluate whether, to what extent, and for which factors the survival of IPF in a real-life setting has changed in the last 15 years. Methods Historical eye is an observational study of a large cohort of consecutive IPF patients diagnosed and treated in a referral center for ILDs with prospective intention. We recruited all consecutive IPF patients seen at GB Morgagni Hospital, Forlì, Italy between January 2002 and December 2016 (15 years). We used survival analysis methods to describe and model the time to death or lung transplant and Cox regression to model prevalent and incident patient characteristics (time-dependent Cox models were fitted). Measurements and main results The study comprised 634 patients. The year 2012 identifies the time point of mortality shift (HR 0.58, CI 0.46-0.63, p < 0.001). In the more recent cohort, more patients had better preserved lung function, underwent cryobiopsy instead of surgery, and were treated with antifibrotics. Highly significant negative prognostic factors were lung cancer (HR 4.46, 95% CI 3.3-6, p < 0.001), hospitalizations (HR 8.37, 95% CI 6.5-10.7, p < 0.001), and acute exacerbations (HR 8.37, 95% CI 6.52-10.7, p < 0.001). The average antifibrotic treatment effect estimated using propensity score matching showed a significant effect in the reduction of all-cause mortality (ATE coeff -0.23, SE 0.04, p < 0.001), acute exacerbations (ATE coeff -0.15, SE 0.04, p < 0.001), and hospitalizations (ATE coeff -0.15, SE 0.04, p < 0.001) but no effect on lung cancer risk (ATE coeff -0.03, SE 0.03, p = 0.4). Conclusion Antifibrotic drugs significantly impact hospitalizations, acute exacerbations, and IPF survival. After the introduction of cryobiopsy and antifibrotic drugs, the prognosis of IPF patients has significantly improved together with our ability to detect IPF at an earlier stage.
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Affiliation(s)
- Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Claudia Ravaglia
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | - Sara Piciucchi
- Radiology Department, Ospedale GB Morgagni, Forlì, Italy
| | - Jay Ryu
- Respiratory and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Athol Wells
- ILD Unit, Pulmonary Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Luca Donati
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
| | | | - Catherine Klersy
- Servizio di Biometria ed Epidemiologia Clinica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Valentina Luzzi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Leonardo Gori
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Elisabetta Rosi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Federico Lavorini
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital, Florence, Italy
| | - Venerino Poletti
- Pulmonary Unit, Department of Diseases of the Thorax, GB Morgagni Hospital, Forlì, Italy
- Department of Respiratory Diseases and Allergology, Aarhus University Hospital, Aarhus, Denmark
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31
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Bleinc A, Blin T, Legue S, Mankikian J, Plantier L, Marchand-Adam S. [Real-life survival of idiopathic pulmonary fibrosis with anti-fibrotic medication]. Rev Mal Respir 2023; 40:371-381. [PMID: 37117065 DOI: 10.1016/j.rmr.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 03/13/2023] [Indexed: 04/30/2023]
Abstract
INTRODUCTION Idiopathic pulmonary fibrosis (IPF) is an irreversible fibrosing disease with median survival at diagnosis of 2-5 years. That said, pirfenidone and nintedanib slow down the gradual decline in respiratory function. Clinical trials have shown that while they are not curative, these drugs reduce mortality and increase survival time compared to placebo. This objective of this work was to compare the real-life survival of patients with IPF diagnosed at the Tours University Hospital depending on whether or not they took anti-fibrotic medication. METHODS This is a monocentric retrospective study involving 176 patients diagnosed with IPF starting from 1997. Out of these 176 patients, 100 were treated with anti-fibrotic agents and 76 did not receive any anti-fibrotic treatment. RESULTS Survival significantly increased in the group with anti-fibrotic medication, with median survival of 59 months [46-87] versus 39 months [29-65] (P=0.022). Predictive factors for death were neoplasia, IPF exacerbation and decreased DLCO. CONCLUSION Our study corroborates the beneficial result observed in clinical trials by showing longer survival in patients using anti-fibrotic agents.
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Affiliation(s)
- Alexandre Bleinc
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France.
| | - Timothée Blin
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Inserm UMR 1100, université François-Rabelais, faculté de médecine de Tours, Tours, France
| | - Sylvie Legue
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Julie Mankikian
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France
| | - Laurent Plantier
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Inserm UMR 1100, université François-Rabelais, faculté de médecine de Tours, Tours, France
| | - Sylvain Marchand-Adam
- Service de pneumologie et des explorations fonctionnelles respiratoires, CHRU de Tours, Tours, France; Inserm UMR 1100, université François-Rabelais, faculté de médecine de Tours, Tours, France
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32
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Hosseini M, Salvatore M. Is pulmonary fibrosis a precancerous disease? Eur J Radiol 2023; 160:110723. [PMID: 36738599 DOI: 10.1016/j.ejrad.2023.110723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/14/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
Idiopathic pulmonary fibrosis (IPF) is the most common type of interstitial lung disease (ILD) characterized by a histopathological pattern of usual interstitial pneumonia with progressive fibrosis of the pulmonary epithelium. The incidence of IPF is increasing worldwide as the population ages and with that, there is a concomitant increase in the incidence of lung cancer in these patients who are living longer with the disease. The average length of time for lung cancer development following an IPF diagnosis is 3 years. Given the high prevalence of lung cancer among patients with pulmonary fibrosis, we wondered if pulmonary fibrosis could be classified as a precancerous disease. We provided support from the Pubmed published literature to investigate whether pulmonary fibrosis meets the five criteria of the National Cancer Institute's definition of premalignant conditions for classification as a precancerous disease. We found out pulmonary fibrosis meets the five criteria of the National Cancer Institute's definition of a premalignant condition and can be considered a precancerous disease. To identify early lung cancer in patients with pulmonary fibrosis, regular screening with HRCT and PET-CT scans is highly recommended for these patients.
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Affiliation(s)
- Mahdie Hosseini
- Department of Radiology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Mary Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
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Miyamoto A, Michimae H, Nakahara Y, Akagawa S, Nakagawa K, Minegishi Y, Ogura T, Hontsu S, Date H, Takahashi K, Homma S, Kishi K. Chemotherapy versus best supportive care in advanced lung cancer and idiopathic interstitial pneumonias: A retrospective multi-centre cohort study. Respir Investig 2023; 61:284-295. [PMID: 36496345 DOI: 10.1016/j.resinv.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/05/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The clinical questions of whether chemotherapy as initial treatment, compared with best supportive care (BSC), improves overall survival (OS) and whether it increases the occurrence risk of acute exacerbation of idiopathic interstitial pneumonia (IIP) in patients with advanced-stage lung cancer and IIP remain inconclusive. This study addresses these issues, given that chemotherapy-related acute exacerbation of IIP may be a direct cause of mortality in these patients. METHODS We enrolled 1003 patients from 110 Japanese institutions and collected clinical profiles from 707 and 296 patients in the chemotherapy (men: women, 645:62; mean age, 70.4 ± 6.9 years) and BSC (men: women, 261:35; mean age, 75.2 ± 7.8) groups, respectively. We used propensity score matching to create 222 matched pairs from both groups using patient demographic data (age, sex, smoking status, performance status, history of acute exacerbation of IIP, desaturation on exertion, clinical diagnosis of IIP, high-resolution computed tomography findings, serum fibrotic markers, pulmonary function status, and lung cancer histopathology). Logistic or Cox regression analyses were performed using matched data to assess the effects of chemotherapy on the risk of acute exacerbation of IIP or OS, respectively. RESULTS In the well-matched cohort, chemotherapy improved OS (hazard ratio: 0.629, 95% confidence interval [CI]: 0.506-0.783, p < 0.0001); however, it involved significant acute exacerbation of IIP (odds ratio: 1.787, 95% CI: 1.026-3.113) compared to BSC. CONCLUSIONS Compared with BSC, chemotherapy can improve OS in patients with advanced-stage lung cancer and IIP; however, it increases the risk of acute exacerbation of IIP.
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Affiliation(s)
- Atsushi Miyamoto
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan; Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan.
| | - Hirofumi Michimae
- School of Pharmacy, Department of Clinical Medicine (Biostatistics), Kitasato University, 5-9-1 Shirokane Minato-ku, Tokyo, 108-8642, Japan
| | - Yasuharu Nakahara
- Department of Respiratory Medicine, National Hospital Organization, Himeji Medical Centre, 68 hon-machi Himeji-shi, Hyogo, 670-8520, Japan
| | - Shinobu Akagawa
- Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital; 3-1-1 Takeoka Kiyose-shi, Tokyo, 204-8585, Japan
| | - Kazuhiko Nakagawa
- Department of Respiratory Medicine, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka 543-8555, Japan
| | - Yuji Minegishi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School University, 1-1-5 Sendagi Bunkyo-ku Tokyo, 113-8602, Japan
| | - Takashi Ogura
- Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Centre, 6-16-1 Tomioka-higashi Kanazawa-ku Yokohama-shi, Kanagawa, 236-0051, Japan
| | - Shigeto Hontsu
- Department of Respiratory Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan
| | - Hiroshi Date
- Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Sakae Homma
- Department of Respiratory Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi Ota-ku, Tokyo, 143-8541, Japan
| | - Kazuma Kishi
- Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan
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Im Y, Chung MP, Lee KS, Han J, Chung MJ, Kim HK, Cho JH, Choi YS, Park S, Kim HJ, Kwon OJ, Park B, Yoo H. Impact of interstitial lung abnormalities on postoperative pulmonary complications and survival of lung cancer. Thorax 2023; 78:183-190. [PMID: 35688622 DOI: 10.1136/thoraxjnl-2021-218055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 05/12/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Interstitial lung abnormalities (ILAs) are associated with the risk of lung cancer and its mortality. However, the impact of ILA on treatment-related complications and survival in patients who underwent curative surgery is still unknown. RESEARCH QUESTION This study aimed to evaluate the significance of the presence of computed tomography-diagnosed ILA and histopathologically matched interstitial abnormalities on postoperative pulmonary complications (PPCs) and the long-term survival of patients who underwent surgical treatment for lung cancer. STUDY DESIGN AND METHODS A matched case-control study was designed to compare PPCs and mortality among 50 patients with ILA, 50 patients with idiopathic pulmonary fibrosis (IPF) and 200 controls. Cases and controls were matched by sex, age, smoking history, tumour location, the extent of surgery, tumour histology and pathological TNM stage. RESULTS Compared with the control group, the OR of the prevalence of PPCs increased to 9.56 (95% CI 2.85 to 32.1, p<0.001) in the ILA group and 56.50 (95% CI 17.92 to 178.1, p<0.001) in the IPF group. The 5-year overall survival (OS) rates of the control, ILA and IPF groups were 76% (95% CI 71% to 83%), 52% (95% CI 37% to 74%) and 32% (95% CI 19% to 53%), respectively (log-rank p<0.001). Patients with ILA had better 5-year OS than those with IPF (log-rank p=0.046) but had worse 5-year OS than those in the control group (log-rank p=0.002). CONCLUSIONS The presence of radiological and pathological features of ILA in patients with lung cancer undergoing curative surgery was associated with frequent complications and decreased survival.
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Affiliation(s)
- Yunjoo Im
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Man Pyo Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Soo Lee
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Myung Jin Chung
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Kwan Kim
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong Ho Cho
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sujin Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho Joong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - O Jung Kwon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Boram Park
- Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
| | - Hongseok Yoo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Karampitsakos T, Spagnolo P, Mogulkoc N, Wuyts WA, Tomassetti S, Bendstrup E, Molina-Molina M, Manali ED, Unat ÖS, Bonella F, Kahn N, Kolilekas L, Rosi E, Gori L, Ravaglia C, Poletti V, Daniil Z, Prior TS, Papanikolaou IC, Aso S, Tryfon S, Papakosta D, Tzilas V, Balestro E, Papiris S, Antoniou K, Bouros D, Wells A, Kreuter M, Tzouvelekis A. Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe. Respirology 2023; 28:56-65. [PMID: 36117239 DOI: 10.1111/resp.14363] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/18/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE There remains a paucity of large databases for patients with idiopathic pulmonary fibrosis (IPF) and lung cancer. We aimed to create a European registry. METHODS This was a multicentre, retrospective study across seven European countries between 1 January 2010 and 18 May 2021. RESULTS We identified 324 patients with lung cancer among 3178 patients with IPF (prevalence = 10.2%). By the end of the 10 year-period following IPF diagnosis, 26.6% of alive patients with IPF had been diagnosed with lung cancer. Patients with IPF and lung cancer experienced increased risk of all-cause mortality than IPF patients without lung cancer (HR: 1.51, [95% CI: 1.22-1.86], p < 0.0001). All-cause mortality was significantly lower for patients with IPF and lung cancer with a monocyte count of either <0.60 or 0.60-<0.95 K/μl than patients with monocyte count ≥0.95 K/μl (HR [<0.60 vs. ≥0.95 K/μl]: 0.35, [95% CI: 0.17-0.72], HR [0.60-<0.95 vs. ≥0.95 K/μl]: 0.42, [95% CI: 0.21-0.82], p = 0.003). Patients with IPF and lung cancer that received antifibrotics presented with decreased all cause-mortality compared to those who did not receive antifibrotics (HR: 0.61, [95% CI: 0.42-0.87], p = 0.006). In the adjusted model, a significantly lower proportion of surgically treated patients with IPF and otherwise technically operable lung cancer experienced all-cause mortality compared to non-surgically treated patients (HR: 0.30 [95% CI: 0.11-0.86], p = 0.02). CONCLUSION Lung cancer exerts a dramatic impact on patients with IPF. A consensus statement for the management of patients with IPF and lung cancer is sorely needed.
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Affiliation(s)
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Nesrin Mogulkoc
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Wim A Wuyts
- Unit of Interstitial Lung Diseases, Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Elisabeth Bendstrup
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Molina-Molina
- Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ömer Selim Unat
- Department of Pulmonology, Ege University Hospital, Izmir, Turkey
| | - Francesco Bonella
- Center for Interstitial and Rare Lung Diseases, Pneumonology Department, Ruhrlandklinik University Hospital, University of Duisburg-Essen, Essen, Germany
| | - Nicolas Kahn
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Lykourgos Kolilekas
- 7th Department of Respiratory Medicine, Hospital for Thoracic Diseases, 'SOTIRIA', Athens, Greece
| | - Elisabetta Rosi
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Leonardo Gori
- Department of Clinical and Experimental Medicine, Interventional Pulmonology Unit, Careggi University Hospital Florence, Florence, Italy
| | - Claudia Ravaglia
- Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Venerino Poletti
- Thoracic Diseases Department, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Zoe Daniil
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Thomas Skovhus Prior
- Center for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Samantha Aso
- Respiratory Department, Unit of Interstitial Lung Diseases, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Stavros Tryfon
- Pulmonary Clinic, NHS General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Despoina Papakosta
- Pulmonary Department, 'G Papanikolaou' General Hospital, Thessaloniki, Greece.,Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Vasillios Tzilas
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabetta Balestro
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Spyridon Papiris
- 2nd Pulmonary Medicine Department, 'ATTIKON' University Hospital, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Antoniou
- Department of Thoracic Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Hospital for Thoracic Diseases, 'SOTIRIA', Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athol Wells
- Interstitial Lung Disease Unit, Ιmperial College London, Royal Brompton and Harefield, London, UK
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Department of Pneumology, Thoraxklinik-University Clinic Heidelberg and German Center for Lung Research, Heidelberg, Germany
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University Hospital of Patras, Patras, Greece
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Ki MS, Kim SY, Kim EY, Jung JY, Kang YA, Park MS, Kim YS, Park SY, Lee SH. Clinical Outcomes and Prognosis of Patients With Interstitial Lung Disease Undergoing Lung Cancer Surgery: A Propensity Score Matching Study. Clin Lung Cancer 2023; 24:e27-e38. [PMID: 36376171 DOI: 10.1016/j.cllc.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/22/2022] [Accepted: 10/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients with interstitial lung disease (ILD) may have a poor prognosis after lung cancer surgery because of respiratory complications and increased recurrence rates due to limited resection. Few studies have investigated prognosis after surgery by matching clinical variables between patients with and without ILD. PATIENTS AND METHODS Medical records of patients who underwent lung cancer surgery between January 2010 and August 2020 at a referral hospital in South Korea were reviewed. Patients with ILD were identified based on preoperative computed tomography findings. Through propensity score matching, the clinical outcomes and prognoses of patients with (ILD group) and without ILD (control group) were compared. RESULTS Of 1629 patients, 113 (6.9%) patients with ILD were identified, of whom 104 patients were matched. Before matching, patients with ILD had higher mean age, proportion of men, and rates of sublobar resection and squamous cell carcinoma than those without ILD. After matching, there was no significant difference in postoperative mortality rates between the control and ILD groups. The 5-year survival rate was significantly lower in the ILD group (66%) than in the control group (78.8%; P= .007). The 5-year survival rate of the ILD-GAP (Gender, Age, Physiology) stage III group (12.6%) was significantly lower than that of the ILD-GAP stage I (73.5%) and II groups (72.6%; P< .0001). Multivariable Cox analysis demonstrated that idiopathic pulmonary fibrosis, higher clinical stage, and recurrence were independent prognostic factors for mortality. CONCLUSION Concomitant ILD negatively affects long-term prognosis after lung cancer surgery, and ILD subtype and physiological severity assessment help predict prognosis after surgery.
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Affiliation(s)
- Min Seo Ki
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Song Yee Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Young Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Ae Kang
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moo Suk Park
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sam Kim
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seong Yong Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang Hoon Lee
- Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Jiang A, Liu N, Wang J, Zheng X, Ren M, Zhang W, Yao Y. The role of PD-1/PD-L1 axis in idiopathic pulmonary fibrosis: Friend or foe? Front Immunol 2022; 13:1022228. [PMID: 36544757 PMCID: PMC9760949 DOI: 10.3389/fimmu.2022.1022228] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/16/2022] [Indexed: 12/08/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating interstitial lung disease with a bleak prognosis. Mounting evidence suggests that IPF shares bio-molecular similarities with lung cancer. Given the deep understanding of the programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) pathway in cancer immunity and the successful application of immune checkpoint inhibitors (ICIs) in lung cancer, recent studies have noticed the role of the PD-1/PD-L1 axis in IPF. However, the conclusions are ambiguous, and the latent mechanisms remain unclear. In this review, we will summarize the role of the PD-1/PD-L1 axis in IPF based on current murine models and clinical studies. We found that the PD-1/PD-L1 pathway plays a more predominant profibrotic role than its immunomodulatory role in IPF by interacting with multiple cell types and pathways. Most preclinical studies also indicated that blockade of the PD-1/PD-L1 pathway could attenuate the severity of pulmonary fibrosis in mice models. This review will bring significant insights into understanding the role of the PD-1/PD-L1 pathway in IPF and identifying new therapeutic targets.
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Affiliation(s)
- Aimin Jiang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Na Liu
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Jingjing Wang
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiaoqiang Zheng
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,Institute for Stem Cell & Regenerative Medicine, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Mengdi Ren
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Wei Zhang
- Military Physical Education Teaching and Research Section of Air Force Medical Service Training Base, Air Force Medical University, Xi’an, China,*Correspondence: Yu Yao, ; Wei Zhang,
| | - Yu Yao
- Department of Medical Oncology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China,*Correspondence: Yu Yao, ; Wei Zhang,
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Otsubo K, Kishimoto J, Ando M, Kenmotsu H, Minegishi Y, Horinouchi H, Kato T, Ichihara E, Kondo M, Atagi S, Tamiya M, Ikeda S, Harada T, Takemoto S, Hayashi H, Nakatomi K, Kimura Y, Kondoh Y, Kusumoto M, Ichikado K, Yamamoto N, Nakagawa K, Nakanishi Y, Okamoto I. Nintedanib plus chemotherapy for nonsmall cell lung cancer with idiopathic pulmonary fibrosis: a randomised phase 3 trial. Eur Respir J 2022; 60:2200380. [PMID: 35361630 DOI: 10.1183/13993003.00380-2022] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 03/12/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a fatal lung disease implicated as an independent risk factor for lung cancer. However, optimal treatment for advanced lung cancer with IPF remains to be established. We performed a randomised phase 3 trial (J-SONIC) to assess the efficacy and safety of nintedanib plus chemotherapy (experimental arm) compared with chemotherapy alone (standard-of-care arm) for advanced nonsmall cell lung cancer (NSCLC) with IPF. METHODS Chemotherapy-naïve advanced NSCLC patients with IPF were allocated to receive carboplatin (area under the curve of 6 on day 1) plus nanoparticle albumin-bound paclitaxel (nab-paclitaxel) (100 mg·m-2 on days 1, 8 and 15) every 3 weeks with or without nintedanib (150 mg twice daily, daily). The primary end-point was exacerbation-free survival (EFS). RESULTS Between May 2017 and February 2020, 243 patients were enrolled. Median EFS was 14.6 months in the nintedanib plus chemotherapy group and 11.8 months in the chemotherapy group (hazard ratio (HR) 0.89, 90% CI 0.67-1.17; p=0.24), whereas median progression-free survival was 6.2 and 5.5 months, respectively (HR 0.68, 95% CI 0.50-0.92). Overall survival was improved by nintedanib in patients with nonsquamous histology (HR 0.61, 95% CI 0.40-0.93) and in those at GAP (gender-age-physiology) stage I (HR 0.61, 95% CI 0.38-0.98). Seven (2.9%) out of 240 patients experienced acute exacerbation during study treatment. CONCLUSIONS The primary end-point of the study was not met. However, carboplatin plus nab-paclitaxel was found to be effective and tolerable in advanced NSCLC patients with IPF. Moreover, nintedanib in combination with such chemotherapy improved overall survival in patients with nonsquamous histology.
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Affiliation(s)
- Kohei Otsubo
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Dept of Respiratory Medicine, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Masahiko Ando
- Dept of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hirotsugu Kenmotsu
- Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Japan
| | - Yuji Minegishi
- Dept of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
- Dept of Respiratory Medicine, Mitsui Memorial Hospital, Tokyo, Japan
| | | | - Terufumi Kato
- Dept of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Eiki Ichihara
- Dept of Allergy and Respiratory Medicine, Okayama University Hospital, Okayama, Japan
| | - Masashi Kondo
- Dept of Respiratory Medicine, Fujita Health University School of Medicine, Toyoake, Japan
| | - Shinji Atagi
- Dept of Thoracic Oncology, National Hospital Organization Kinki-chuo Chest Medical Center, Sakai, Japan
| | - Motohiro Tamiya
- Dept of Thoracic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Satoshi Ikeda
- Dept of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Toshiyuki Harada
- Dept of Respiratory Medicine, JCHO Hokkaido Hospital, Sapporo, Japan
| | - Shinnosuke Takemoto
- Dept of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hidetoshi Hayashi
- Dept of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Keita Nakatomi
- Division of Respiratory Medicine, Kyushu Central Hospital, Fukuoka, Japan
| | - Yuichiro Kimura
- Dept of Pulmonary Medicine, Sendai Kousei Hospital, Sendai, Japan
| | - Yasuhiro Kondoh
- Dept of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Masahiko Kusumoto
- Dept of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazuya Ichikado
- Division of Respiratory Medicine, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Kazuhiko Nakagawa
- Dept of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoichi Nakanishi
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Kitakyushu City Hospital Organization, Kitakyushu, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abu Qubo A, Numan J, Snijder J, Padilla M, Austin JH, Capaccione KM, Pernia M, Bustamante J, O'Connor T, Salvatore MM. Idiopathic pulmonary fibrosis and lung cancer: future directions and challenges. Breathe (Sheff) 2022; 18:220147. [PMID: 36865932 PMCID: PMC9973524 DOI: 10.1183/20734735.0147-2022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive disease of pulmonary scarring. New treatments slow disease progression and allow pulmonary fibrosis patients to live longer. Persistent pulmonary fibrosis increases a patient's risk of developing lung cancer. Lung cancer in patients with IPF differs from cancers that develop in the non-fibrotic lung. Peripherally located adenocarcinoma is the most frequent cell type in smokers who develop lung cancer, while squamous cell carcinoma is the most frequent in pulmonary fibrosis. Increased fibroblast foci in IPF are associated with more aggressive cancer behaviour and shorter doubling times. Treatment of lung cancer in fibrosis is challenging because of the risk of inducing an exacerbation of fibrosis. In order to improve patient outcomes, modifications of current lung cancer screening guidelines in patients with pulmonary fibrosis will be necessary to avoid delays in treatment. 2-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET) computed tomography (CT) imaging can help identify cancer earlier and more reliably than CT alone. Increased use of wedge resections, proton therapy and immunotherapy may increase survival by decreasing the risk of exacerbation, but further research will be necessary.
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Affiliation(s)
- Ahmad Abu Qubo
- Department of Pathology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Jamil Numan
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Juan Snijder
- Department of Pediatrics, Einstein Medical Center, Philadelphia, PA, USA
| | - Maria Padilla
- Department of Pulmonary Medicine, Mount Sinai, New York, NY, USA
| | - John H.M. Austin
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | | | - Monica Pernia
- Department of Medicine, Metropolitan Hospital, New York, NY, USA
| | - Jean Bustamante
- Department of Oncology, West Virginia University, Morgantown, WV, USA
| | - Timothy O'Connor
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Mary M. Salvatore
- Department of Radiology, Columbia University Medical Center, New York, NY, USA,Corresponding author: Mary M. Salvatore ()
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40
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Frank AJ, Dagogo-Jack I, Dobre IA, Tait S, Schumacher L, Fintelmann FJ, Fingerman LM, Keane FK, Montesi SB. Management of Lung Cancer in the Patient with Interstitial Lung Disease. Oncologist 2022; 28:12-22. [PMID: 36426803 PMCID: PMC9847545 DOI: 10.1093/oncolo/oyac226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022] Open
Abstract
Patients with interstitial lung disease (ILD), especially those with pulmonary fibrosis, are at increased risk of developing lung cancer. Management of lung cancer in patients with ILD is particularly challenging. Diagnosis can be complicated by difficulty differentiating lung nodules from areas of focal fibrosis, and percutaneous biopsy approaches confer an increased risk of complications in those with pulmonary fibrosis. Lung cancer treatment in these patients pose several specific considerations. The degree of lung function impairment may preclude lobectomy or surgical resection of any type. Surgical resection can trigger an acute exacerbation of the underlying ILD. The presence of ILD confers an increased risk of pneumonitis with radiotherapy, and many of the systemic therapies also carry an increased risk of pneumonitis in this population. The safety of immunotherapy in the setting of ILD remains to be fully elucidated and concerns remain as to triggering pneumonitis. The purpose of this review is to summarize the evidence regarding consideration for tissue diagnosis, chemotherapy and immunotherapy, radiotherapy, and surgery, in this patient population and discuss emerging areas of research. We also propose a multidisciplinary approach and practical considerations for monitoring for ILD progression during lung cancer treatment.
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Affiliation(s)
| | | | - Ioana A Dobre
- Queen’s University School of Medicine, Kingston, ON, Canada
| | - Sarah Tait
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Lana Schumacher
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Florian J Fintelmann
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital, Boston, MA, USA
| | - Leah M Fingerman
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Sydney B Montesi
- Corresponding author: Sydney B. Montesi, MD, Massachusetts General Hospital, 55 Fruit Street, BUL-148, Boston, MA 02114, USA. Tel: +1 617 724 4030;
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Perrotta F, Chino V, Allocca V, D’Agnano V, Bortolotto C, Bianco A, Corsico AG, Stella GM. Idiopathic pulmonary fibrosis and lung cancer: targeting the complexity of the pharmacological interconnection. Expert Rev Respir Med 2022; 16:1043-1055. [DOI: 10.1080/17476348.2022.2145948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Fabio Perrotta
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Vittorio Chino
- - University of Pavia Medical School, 27100 Pavia, Italy
- - Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Valentino Allocca
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Vito D’Agnano
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Chandra Bortolotto
- - Dept. of Clinical-Surgical, Diagnostic and Paediatric Sciences, University of Pavia Medical School, Pavia, Italy
- - Department of Intensive Medicine, Unit of Radiology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Andrea Bianco
- - Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, 80131, Napoli, Italy
- - U.O.C. Clinica Pneumologica “L. Vanvitelli”, A.O. dei Colli, Ospedale Monaldi, 80131, Napoli, Italy
| | - Angelo Guido Corsico
- - Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
- - Dept. of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, Pavia, Italy
| | - Giulia Maria Stella
- - Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
- - Dept. of Internal Medicine and Medical Therapeutics, University of Pavia Medical School, Pavia, Italy
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Koga T, Okamoto M, Satoh M, Fujimoto K, Zaizen Y, Chikasue T, Sumi A, Kaieda S, Matsuo N, Matama G, Nouno T, Tominaga M, Yatera K, Ida H, Hoshino T. Positive Autoantibody Is Associated with Malignancies in Patients with Idiopathic Interstitial Pneumonias. Biomedicines 2022; 10:biomedicines10102469. [PMID: 36289730 PMCID: PMC9598916 DOI: 10.3390/biomedicines10102469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Various autoantibodies are associated with clinical outcomes in patients with idiopathic interstitial pneumonias (IIPs). We retrospectively analyzed the association between autoantibodies and malignancies in IIP patients. Comprehensive analyses of autoantibodies were performed using immunoprecipitation and enzyme-linked immunosorbent assays in 193 consecutive IIP patients. Cancer-related factors were analyzed using logistic regression analysis. In total, 22 of 193 patients (11.4%) with IIP had malignant disease. In univariate analysis, positivity for any autoantibody (odds ratio (OR), 3.1; 95% confidence interval (CI), 1.2-7.7; p = 0.017) and antinuclear antibody titer ≥1:320 (OR, 3.4; CI, 1.2-9.8; p = 0.024) were significantly associated with malignancies. Positive anti-aminoacyl tRNA synthetase (ARS) (OR, 3.7; CI, 0.88-15.5; p = 0.074) and anti-Ro52 antibody (OR, 3.2; CI, 0.93-11.2; p = 0.065) tended to be associated with malignancies. In multivariate analysis, independent risk factors were male sex (OR, 3.7; CI, 1.0-13.5; p = 0.029) and positivity for any autoantibody (OR, 3.9; CI, 1.5-10.1; p = 0.004) in model 1, and male sex (OR, 3.9; CI, 1.0-15.3; p = 0.049), antinuclear antibody titer ≥1:320 (OR, 4.2; CI, 1.4-13.3; p = 0.013), and positivity for anti-ARS antibody (OR, 6.5; CI, 1.2-34.1; p = 0.026) in model 2. Positivity for any autoantibody, antinuclear and anti-ARS antibodies, and male sex were independent risk factors for malignancies in IIP patients. Testing autoantibodies in IIP patients might help the early diagnosis of malignancies.
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Affiliation(s)
- Takuma Koga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Masaki Okamoto
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
- Correspondence: ; Tel.: +81-92-852-0700
| | - Minoru Satoh
- Department of Clinical Nursing, School of Health Sciences, University of Occupational and Environmental Health, Fukuoka 807-8555, Japan
- Department of Medicine, Kitakyushu Yahata Higashi Hospital, Fukuoka 805-0071, Japan
| | - Kiminori Fujimoto
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Yoshiaki Zaizen
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Tomonori Chikasue
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Akiko Sumi
- Department of Radiology, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Shinjiro Kaieda
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
| | - Goushi Matama
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Takashi Nouno
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
- Department of Respirology and Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka 810-0065, Japan
| | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Japan, Fukuoka 807-8555, Japan
| | - Hiroaki Ida
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Kurume 830-0011, Japan
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Akaike K, Saruwatari K, Matsushima R, Fujino K, Morinaga J, Oda S, Takahashi H, Shiraishi S, Okabayashi H, Hamada S, Tomita Y, Masunaga A, Saeki S, Ikeda K, Ichiyasu H, Suzuki M, Sakagami T. Clinical impact of SUV max of interstitial lesions in lung cancer patients with interstitial lung disease who underwent pulmonary resection. J Thorac Dis 2022; 14:3801-3810. [PMID: 36389305 PMCID: PMC9641318 DOI: 10.21037/jtd-22-604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute exacerbation of interstitial lung disease often causes fatal respiratory deterioration in lung cancer patients with interstitial lung disease. Here, we examined whether the maximum standardized uptake value of a contralateral interstitial lesion was a predictive factor of acute exacerbation of interstitial lung disease within 30 days postoperatively in lung cancer patients with interstitial lung disease who underwent pulmonary resection. METHODS Overall, 117 consecutive lung cancer patients with interstitial lung disease who underwent pulmonary resection between August 2010 and April 2019 at the Kumamoto University Hospital were retrospectively analysed for the association between the maximum standardized uptake value of the contralateral interstitial lesions and interstitial lung disease parameters. RESULTS The median maximum standardized uptake value of contralateral interstitial lesions was 1.61, which was regarded as the cut-off point predictive of the incidence of acute exacerbation of interstitial lung disease. Eight patients developed postoperative acute exacerbation of interstitial lung disease. There was no significant association between the maximum standardized uptake value of the contralateral interstitial lesions and postoperative acute exacerbation of interstitial lung disease. The maximum standardized uptake value was weakly but significantly associated with lactate dehydrogenase levels (r=0.211, P=0.022), Krebs von den Lungen-6 (r=0.208, P=0.028), and % diffusing capacity for carbon monoxide (r=-0.290, P=0.002). Moreover, seven patients developed acute exacerbation of the interstitial lung disease during the clinical course after 30 postoperative days, and the incidence rate of acute exacerbation of interstitial lung disease was significantly higher in the high maximum standardized uptake value group (≥1.61) than in the low maximum standardised uptake value group (<1.61) (12.7% vs. 0%, P=0.002, Gray's test). CONCLUSIONS Maximum standardized uptake value was not a predictor of postoperative acute exacerbation of interstitial lung disease in lung cancer patients with interstitial lung disease after pulmonary resection, but could be a predictive tool of an association with interstitial lung disease severity and activity markers.
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Affiliation(s)
- Kimitaka Akaike
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Koichi Saruwatari
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Ryohei Matsushima
- Department of Thoracic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kosuke Fujino
- Department of Thoracic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jun Morinaga
- Department of Clinical Investigation, Kumamoto University Hospital, Kumamoto, Japan
| | - Seitaro Oda
- Department of Diagnostic Radiology, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Takahashi
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shinya Shiraishi
- Department of Diagnostic Radiology, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroko Okabayashi
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Shohei Hamada
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Yusuke Tomita
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Aiko Masunaga
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Sho Saeki
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Koei Ikeda
- Department of Thoracic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hidenori Ichiyasu
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Makoto Suzuki
- Department of Thoracic Surgery, Kumamoto University Hospital, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takuro Sakagami
- Department of Respiratory Medicine, Kumamoto University Hospital, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Bade B, Gwin M, Triplette M, Wiener RS, Crothers K. Comorbidity and life expectancy in shared decision making for lung cancer screening. Semin Oncol 2022; 49:S0093-7754(22)00057-4. [PMID: 35940959 DOI: 10.1053/j.seminoncol.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/02/2022] [Accepted: 07/03/2022] [Indexed: 11/11/2022]
Abstract
Shared decision making (SDM) is an important part of lung cancer screening (LCS) that includes discussing the risks and benefits of screening, potential outcomes, patient eligibility and willingness to participate, tobacco cessation, and tailoring a strategy to an individual patient. More than other cancer screening tests, eligibility for LCS is nuanced, incorporating the patient's age as well as tobacco use history and overall health status. Since comorbidities and multimorbidity (ie, 2 or more comorbidities) impact the risks and benefits of LCS, these topics are a fundamental part of decision-making. However, there is currently little evidence available to guide clinicians in addressing comorbidities and an individual's "appropriateness" for LCS during SDM visits. Therefore, this literature review investigates the impact of comorbidities and multimorbidity among patients undergoing LCS. Based on available evidence and guideline recommendations, we identify comorbidities that should be considered during SDM conversations and review best practices for navigating SDM conversations in the context of LCS. Three conditions are highlighted since they concomitantly portend higher risk of developing lung cancer, potentially increase risk of screening-related evaluation and treatment complications and can be associated with limited life expectancy: chronic obstructive pulmonary disease, idiopathic pulmonary fibrosis, and human immunodeficiency virus infection.
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Affiliation(s)
- Brett Bade
- Veterans Affairs (VA) Connecticut Healthcare System, Section of Pulmonary, Critical Care, and Sleep Medicine, West Haven, CT, United States of America (USA); Yale University School of Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, CT, USA.
| | - Mary Gwin
- University of Washington School of Medicine, Seattle, WA, USA
| | - Matthew Triplette
- University of Washington School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Center, Clinical Research Division, Seattle, WA, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization & Implementation Research and Medical Service, VA Boston Healthcare System, Boston, MA, USA; The Pulmonary Center, Boston University School of Medicine, Boston, MA, USA
| | - Kristina Crothers
- University of Washington School of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA; VA Puget Sound Health Care System, Section of Pulmonary, Critical Care and Sleep Medicine, Seattle, WA, USA
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Small Cell Lung Cancer in the Course of Idiopathic Pulmonary Fibrosis—Case Report and Literature Review. Curr Oncol 2022; 29:5077-5083. [PMID: 35877261 PMCID: PMC9318736 DOI: 10.3390/curroncol29070401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 11/16/2022] Open
Abstract
Idiopathic pulmonary fibrosis is a poorly prognosed form of progressive interstitial pneumonia. Patients with IPF have a significantly increased risk of developing lung cancer, which further worsens the course of the disease. The most common histological types of LC among patients with IPF are squamous cell carcinoma and adenocarcinoma. Furthermore, all LC treatment modalities can lead to developing an acute IPF exacerbation. In this report, we present a rare case of coexistence of IPF and small cell lung cancer in a 76-year-old patient with chronic obstructive pulmonary disease, and a former smoker. For over 2 years, the patient was treated with an anti-fibrotic drug-pirfenidone, which slowed down the progression of IPF. Unfortunately, after being diagnosed with an active SCLC, the patient was excluded from further participation in the pirfenidone drug program. SCLC is characterized by high aggressiveness, rapid growth and high metastatic potential; therefore, it is necessary to apply antitumor treatment as soon as possible. The described patient was treated with carboplatin–etoposide chemotherapy. Early treatment tolerance was good and after two cycles of cytotoxic treatment, a partial response was present in CT. The presented case emphasizes the need for further research to determine the treatment regimens in patients with coexisting IPF and LC and the appropriateness of antifibrotic treatment in them. In addition, it can help to choose the treatment method for similar patients, indicating a combination of carboplatin and etoposide as an effective and, at the same time, relatively safes method in terms of the risk of IPF’s exacerbation.
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Koda K, Enomoto Y, Aoshima Y, Amano Y, Kato S, Hasegawa H, Matsui T, Yokomura K, Mochizuki E, Matsuura S, Koshimizu N, Morita M, Kojima S, Watanabe A, Oyama Y, Ikeda M, Kusagaya H, Uto T, Sato J, Imokawa S, Kono M, Hashimoto D, Kamiya Y, Toyoshima M, Asada K, Morita M, Mikamo M, Yasui H, Hozumi H, Karayama M, Suzuki Y, Furuhashi K, Fujisawa T, Enomoto N, Nakamura Y, Inui N, Suda T. Chemotherapy for patients with advanced lung cancer with interstitial lung disease: a prospective observational study. Ther Adv Chronic Dis 2022; 13:20406223221108395. [PMID: 35782342 PMCID: PMC9243372 DOI: 10.1177/20406223221108395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/01/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction: Although recent advances in chemotherapy for lung cancer are remarkable, most clinical trials have excluded patients with interstitial lung disease (ILD) due to the concern of developing acute exacerbation (AE) of ILD. Hence, accumulating original evidence of cancer treatment for this population is important. Methods: Between 2016 and 2020, a prospective observational study was conducted across 11 Japanese hospitals. Patients with chemotherapy-naïve, inoperable, advanced lung cancer with ILD were included. The primary outcome was the frequency of AE-ILD after registration; the secondary outcomes were the risk factor of AE-ILD and the efficacy of chemotherapy. Results: Among 124 patients enrolled, 109 patients who received chemotherapy were analyzed. The median age was 72 years, and the majority showed usual interstitial pneumonia (UIP)/probable UIP pattern upon chest computed tomography. The median percent-predicted forced vital capacity (%FVC) was 81% (interquartile range: 66–95%). After registration, 23 patients (21.1%; 95% confidence interval [CI]: 14.4–29.7%) developed AE-ILD. The logistic analysis revealed that lower %FVC slightly but significantly increased the risk of AE-ILD (odds ratio per 10% decrease: 1.27; 95% CI: > 1.00–1.62). Overall response rates/median overall survival times in non-small-cell lung cancer and small-cell lung cancer for the first-line chemotherapy were 41% (95% CI: 31–53)/8.9 months (95% CI: 7.6–11.8) and 91% (95% CI: 76–98)/12.2 months (95% CI: 9.2–14.5), respectively. Conclusion: AE-ILD during chemotherapy is a frequent complication among patients with lung cancer with ILD, particularly those with lower %FVC. Conversely, even in this population, passable treatment response can be expected.
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Affiliation(s)
- Keigo Koda
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | | | - Yoichiro Aoshima
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yusuke Amano
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Shinpei Kato
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Hirotsugu Hasegawa
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Takashi Matsui
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan
| | - Eisuke Mochizuki
- Department of Respiratory Medicine, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Shun Matsuura
- Department of Respiratory Medicine, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Naoki Koshimizu
- Department of Respiratory Medicine, Fujieda Municipal General Hospital, Fujieda, Japan
| | - Meiko Morita
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Suguru Kojima
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Ayano Watanabe
- Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan
| | - Yoshiyuki Oyama
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Masaki Ikeda
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Hideki Kusagaya
- Department of Respiratory Medicine, Shizuoka Saiseikai General Hospital, Shizuoka, Japan
| | - Tomohiro Uto
- Division of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Jun Sato
- Division of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Shiro Imokawa
- Division of Respiratory Medicine, Iwata City Hospital, Iwata, Japan
| | - Masato Kono
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Dai Hashimoto
- Department of Pulmonary Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Yosuke Kamiya
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Mikio Toyoshima
- Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan
| | - Kazuhiro Asada
- Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan
| | - Masako Morita
- Department of Respiratory Medicine, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Masashi Mikamo
- Department of Respiratory Medicine, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Hideki Yasui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Park HS, Detterbeck FC, Madoff DC, Bade BC, Kumbasar U, Mase VJ, Li AX, Blasberg JD, Woodard GA, Brandt WS, Decker RH. A guide for managing patients with stage I NSCLC: deciding between lobectomy, segmentectomy, wedge, SBRT and ablation-part 4: systematic review of evidence involving SBRT and ablation. J Thorac Dis 2022; 14:2412-2436. [PMID: 35813762 PMCID: PMC9264060 DOI: 10.21037/jtd-21-1826] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
Background Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options [lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation], weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making. Methods A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation vs. resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved. Results Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT vs. surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation vs. surgery; there is less difference between ablation and SBRT. Conclusions A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation vs. resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
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Affiliation(s)
- Henry S. Park
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
| | - Frank C. Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - David C. Madoff
- Department of Radiology & Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA
| | - Brett C. Bade
- Department of Pulmonary Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Ulas Kumbasar
- Department of Thoracic Surgery, Hacettepe University School of Medicine, Ankara, Turkey
| | - Vincent J. Mase
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew X. Li
- Department of General Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Justin D. Blasberg
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Gavitt A. Woodard
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT, USA
| | - Whitney S. Brandt
- Department of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Roy H. Decker
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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Kewalramani N, Machahua C, Poletti V, Cadranel J, Wells AU, Funke-Chambour M. Lung cancer in patients with fibrosing interstitial lung diseases – An overview of current knowledge and challenges. ERJ Open Res 2022; 8:00115-2022. [PMID: 35747227 PMCID: PMC9209850 DOI: 10.1183/23120541.00115-2022] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/18/2022] [Indexed: 11/30/2022] Open
Abstract
Patients with progressive fibrosing interstitial lung diseases (fILD) have increased morbidity and mortality. Lung fibrosis can be associated with lung cancer. The pathogenesis of both diseases shows similarities, although not all mechanisms are understood. The combination of the diseases is challenging, due to the amplified risk of mortality, and also because lung cancer treatment carries additional risks in patients with underlying lung fibrosis. Acute exacerbations in fILD patients are linked to increased mortality, and the risk of acute exacerbations is increased after lung cancer treatment with surgery, chemotherapy or radiotherapy. Careful selection of treatment modalities is crucial to improve survival while maintaining acceptable quality of life in patients with combined lung cancer and fILD. This overview of epidemiology, pathogenesis, treatment and a possible role for antifibrotic drugs in patients with lung cancer and fILD is the summary of a session presented during the virtual European Respiratory Society Congress in 2021. The review summarises current knowledge and identifies areas of uncertainty. Most current data relate to patients with combined idiopathic pulmonary fibrosis and lung cancer. There is a pressing need for additional prospective studies, required for the formulation of a consensus statement or guideline on the optimal care of patients with lung cancer and fILD. Lung fibrosis can be associated with lung cancer. More and better-designed studies are needed to determine the true incidence/prevalence of lung cancer in fILD. Optimal treatment strategies urgently need to be defined and evaluated.https://bit.ly/37CzTMu
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Pitsidianakis G, Vassalou EE, Vasarmidi E, Bolaki M, Klontzas ME, Xirouchaki N, Georgopoulos D, Karantanas AH, Tzanakis N, Antoniou KM. Performance of Lung Ultrasound for Monitoring Interstitial Lung Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1077-1084. [PMID: 34291845 DOI: 10.1002/jum.15790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES In this study, we sought to assess the validity of lung ultrasound (LUS) during the follow-up of patients with a wide spectrum of interstitial lung diseases (ILDs). METHODS Twenty-four patients (13 males, 11 females; mean age ± SD, 65.4 ± 14.3 years; age range, 40-84 years) with a diagnosis of ILDs who were admitted to the Interstitial Lung Disease Unit were prospectively enrolled. Patients were examined with a 56-lung intercostal space LUS protocol in lateral decubitus position, at baseline, 6-months, and 1-year. The LUS score was defined as the sum of B-lines counted in each intercostal space. All patients underwent complete pulmonary function tests at baseline and follow-up time-points. High-resolution computed tomography (HRCT) was performed at baseline and during follow-up, according to personalized patients' needs. All HRCT studies were graded according to the Warrick scoring system (WS). RESULTS Pooled data analysis showed a significant correlation between WS and LUS scores (P < .001). For separate time-point analysis, a significant correlation between LUS scores and WS was found at baseline (P < .001) and 1 year (P = .005). LUS scores negatively correlated with alveolar volume (VA) (P < .046) and diffusing capacity for carbon monoxide (DLCO) (P < .001) at 6 months and with transfer coefficient of the lung for carbon monoxide (KCO) (P < .031) and DLCO (P = .002) at 12-months. A multivariate regression model showed DLCO to be an independent predictor of LUS score at 1 year (P = .026). CONCLUSIONS Our results highlight the validity and potential applicability of LUS for disease monitoring in a wide spectrum of ILDs.
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Affiliation(s)
| | - Evangelia E Vassalou
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece
- Department of Medical Imaging, Sitia General Hospital, Sitia, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Heraklion University Hospital, Heraklion, Greece
| | - Maria Bolaki
- Department of Intensive Care Medicine, Heraklion University Hospital, Heraklion, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece
| | - Nektaria Xirouchaki
- Department of Intensive Care Medicine, Heraklion University Hospital, Heraklion, Greece
| | | | - Apostolos H Karantanas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, Heraklion University Hospital, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Heraklion University Hospital, Heraklion, Greece
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50
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Naoi H, Suzuki Y, Mori K, Aono Y, Kono M, Hasegawa H, Yokomura K, Inoue Y, Hozumi H, Karayama M, Furuhashi K, Enomoto N, Fujisawa T, Nakamura Y, Inui N, Nakamura H, Suda T. Impact of antifibrotic therapy on lung cancer development in idiopathic pulmonary fibrosis. Thorax 2022; 77:727-730. [PMID: 35354649 DOI: 10.1136/thoraxjnl-2021-218281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/12/2022] [Indexed: 11/03/2022]
Abstract
Patients with idiopathic pulmonary fibrosis (IPF) are at a high risk of lung cancer (LC). Antifibrotic therapy slows disease progression and possibly prolongs survival. However, whether antifibrotic therapy affects LC development in patients with IPF remains unknown. This multicentre retrospective study evaluated 345 patients with IPF. The incidence and prevalence of LC were significantly lower in patients with IPF receiving antifibrotic therapy than those not receiving. Subsequently, LC-related mortality was significantly lower in patients with IPF receiving antifibrotic therapy. These results suggest that antifibrotic therapy was possibly associated with a reduced risk of LC development in patients with IPF, which may be partly associated with its survival benefit.
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Affiliation(s)
- Hyogo Naoi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yuzo Suzuki
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazutaka Mori
- Department of Respiratory Medicine, Shizuoka City Shimizu Hospital, Shizuoka, Japan
| | - Yuya Aono
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Kono
- Department of Respiratory Medicine, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Hirotsugu Hasegawa
- Department of Respiratory Medicine, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Koshi Yokomura
- Department of Respiratory Medicine, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Yusuke Inoue
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hironao Hozumi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Karayama
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Kazuki Furuhashi
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yutaro Nakamura
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Naoki Inui
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hidenori Nakamura
- Department of Respiratory Medicine, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Takafumi Suda
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan
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