To Investigate The Clinical Characteristics Of Idiopathic Pulmonary Fibrosis With Lung Cancer

Objective Studies have shown that patients with idiopathic pulmonary fibrosis have a significantly increased risk of lung cancer.The mortality rate for this combination of diseases is enormous.The clinical features,treatment and prognosis of idiopathic pulmonary fibrosis with lung cancer are still unclear.This study aims to investigate the clinical characteristics,treatment,and prognostic factors of patients with idiopathic pulmonary fibrosis and lung cancer.Methods 135 patients were divided into two groups: idiopathic pulmonary fibrosis group(IPF)and idiopathic pulmonary fibrosis with lung cancer group(IPF-LC).Among them,83 cases of IPF patients and 52 cases of IPF-LC patients were collected.(1)General data(gender,age,smoking index),tumor characteristics(distribution site,pathological type,tumor stage)and diagnostic methods of patients in both groups were collected and analyzed.(2)Clinical manifestations of patients with IPF and IPF-LC on chest CT.(3)Analyze and summarize the treatment methods of IPF-LC patients.(4)Analysis and comparison IPF and IPF-LC two related indicators,including general information(gender,age,smoking index,body mass index),lung function(PFT),blood gas,inflammation index(c-reactive protein and blood sedimentation),albumin,tumor markers(carcinoembryonic antigen,Carbohydrate Antigen 199,Neuron Specific Enolase and cytokeratin 19 fragment).(5)The two groups of patients were followed up,and the follow-up time was from the time of diagnosis to December 2020.To observe whether there was a difference in median survival between the two groups,and whether anti-fibrosis therapy affected the survival of patients with IPF and IPF-LC.Results Among the 52 patients with IPF-LC,most of them were male(n=51,98.1%),the mean age was(68.3±7.3)years;the main pathological types were non-small cell lung cancer(n=40,76.9%);bronchoscopic biopsy and percutaneous lung puncture were the main diagnostic methods for patients with IPF complicated with lung cancer,and the clinical stages were mostly in stage III and IV.In patients with IPF complicated with lung cancer,the lung cancer was mostly located in the periphery of chest CT and pulmonary fibrosis,with more cases in the upper and lower lobes.The treatment is mainly symptomatic support and chemotherapy.A small number of patients received radical surgery(n=3),radiotherapy(n=2),and targeted therapy(n=4).The gender,smoking index,1S rate(FEV1/FVC%),resiual capacity/total lung capacity(RV/TLC %),p H,arterial partial oxygen pressure(PO2),partial carbon dioxide pressure(PCO2),carcinoembryonic antigen(CEA),Neuron Specific Enolase(NSE)and cytokeratin 19 fragment(CYFRA21-1)of IPF and IPF-LC patients were compared between the two groups,and the differences were statistically significant.Through Cox regression model,the age,gender,smoking or not,BMI,FEV1/FVC(%),RV/TLC(%),DLco(mmol/mim/kpa),PH,PO2 mm Hg,PCO2(mm Hg),erythrocyte sedimentation Analysis of factors such as ESR,C-reactive protein(CRP),and human albumin(ALB)showed that age,RV/TLC(%)and CRP are factors that have an impact on the prognosis of IPF-LC patients(age: P = 0.027;RV/TLC%: P = 0.018;CRP: P =0.004).Median survival(MST)was significantly longer in the IPF-LC group than in the IPF group(IPF: 57 months,95%CI: 41.1 to 72.9;IPF-LC: 15 months,95%CI:11.5～18.5),P<0.01.Compared with the IPF group that received antifibrosis therapy(pirfenidone/nine tidanyl),the MST was prolonged,P<0.05.However,whether IPF-LC patients received anti-fibrosis therapy showed no significant difference,P=0.1395.Conclusion1.IPF-LC patients are more common in males and smokers,and are age-related.The pathological type is mainly non-small cell lung cancer.The clinical staging is more common in advanced lung cancer,which is mostly located in the upper lobe,lower lobe and fibrotic areas.2.Age,RV/TLC(%)and CRP are independent factors affecting the prognosis of IPF-LC patients.3.The survival rate of patients with IPF-LC is worse than that of patients with IPF.4.It is recommended that patients with a definite diagnosis of IPF receive anti-fibrosis therapy as early as possible to prolong their survival.