| BackgroudThe 2020 Global Cancer Epidemiology Survey shows that lung cancer(LC)is the second most malignant tumor in the world in way of incidence and The first in mortality,and because most patients are at an advanced stage when they are diagnosed,they have lost the opportunity to operate,and the five-year survival rate is terribly about 21%.Interstitial pneumonia is a large class of non-neoplastic heterogeneous diseases with high morbidity and mortality,and the main subtypes of ILD can be divided into idiopathic fibrosis(IPF),in addition to connective tissue disease-related interstitial lung disease(CTD-ILD),and Interstitial Pneumonia With Autoimmune Features(IPAF).Numerous studies have shown that ILD is an independent risk factor for lung cancer development.in frequency over recent years,the incidence of lung cancer with ILD has also increased significantly,and the emergence of AE in the treatment of lung cancer will greatly affect the quality of life and survival time of lung cancer patients.Raising awareness of the therapeutic and prognostic effects of ILD on lung cancer is therefore critical to developing clinical treatment options.ObjectiveThe objective of this study was to research the effect of ILD on the survival prognosis of lung cancer patients,compare the clinical features of LC-IPF,LC combined CTD-ILD,LC combined with IPAF,the differences in the effect of different subtypes of ILD on the survival prognosis of lung cancer,and look for risk factors affecting the prognosis of patients.To deepen the management and understanding of ILD in lung cancer treatment.MethodsRetrospectively collected and analyzed 160 patients with histopathological biopsy diagnosed as lung malignancy by pathology department from January 2018 to December 2020,40 patients with histopathological diagnosis of lung malignancy with idiopathic pulmonary fibrosis,and 40 patients with lung malignancy with CTD-ILD and 40 patients with lung cancer complicated with IPAF admitted during the same period.The patient’s general clinical data,laboratory test indicators,imaging and pathological data,genetic test results and treatment options are recorded through the electronic medical record system,and statistical analysis is executed.Overall survival(OS)is defined as the interval in months from the date of diagnosis of lung cancer to the dead date or last follow-up for any reason.Follow-up is by telephone or outpatient.Measurement data is expressed as mean±standard deviation(Mean±SD)and count data as percentage(%).Comparison of characteristics between groups,such as the application of t-test is for metrology data,chi-square test for counting data comparison,which is used to compare the differences between the general data,and the test level α=0.05.The Kaplan-Meier method is used for survival analysis and the Log-rank test is used to compare survival rates between groups.After the univariate analysis using the Cox regression model yielded meaningful clinical pathological factors(P<0.10),the Cox regression model was again included for multivariate analysis.Inspection level P<0.05.Results(1)The mean age of onset in LC group,LC-IPF group,LC combined with CTD-ILD group and LC combined with IPAF group was 63.13±8.62 years old,69.45±8.14 years old,66.12±7.15 years old and 67.68±6.94 years old,respectively.Most of the patients were male,and there was no statistically significant difference.The number of smokers in all four groups was larger than that of non-smokers,and the difference was not statistically significant.Our study found that the common characteristics of the patients in the four groups were elderly,male and smokers,with no statistical significance(P>0.05).(2)The expression level of LDH in LC-IPF group and LC combined with IPAF group was significantly higher than that in LC group(P<0.05),and the difference was statistically significant.Inflammation index CRP and tumor markers CEA,NSE between four groups had no significant difference(P>0.05).The expression level of CYFRA21-1 in LC-IPF group was significantly higher than that in LC combined IPAF group,and the difference was statistically significant(P<0.05).(3)Except LC-IPF group the main pathological type is adenocarcinoma and squamous cell carcinomas in LC-IPF group(40.00%)is slightly higher than that of adenocarcinoma(37.50%),most of the late diagnosis.Tumor pathology classification and clinical stage had no significant difference(P>0.05).The proportion of lesions located in peripheral range in LC-IPF group and LC combined with CTD-ILD group was significantly higher than that in LC group(P<0.05).Most of the lesions in the four groups were located in the lower lobe of lung,and the tumor lesion size was ≥3cm.In terms of treatment,the vast majority of patients chose chemotherapy.Few genetic mutations were detected in IPF group,LC combined with CTD-ILD group and LC combined with IPAF group.Most patients with early clinical stage tend to choose surgical treatment.Anticancer therapy was combined with anti-fibrosis therapy in 1C-IPF group and LC combined with CTD-ILD group..(4)LC-ILD and LC group had significant difference in survival prognosis(P<0.05).Tumor type,clinical stage and CRP expression level are prognostic factors related to LC,while ILD is an independent risk factor for survival of patients with LC.(5)Median survival time in IPF group was 14 months.The median overall survival time of LC combined with CTD-ILD group was 16 months.The median overall survival time of patients with LC combined with IPAF was 22 months.The survival analysis of the three groups showed that different types of ILD had significant influence on the survival and prognosis of lung cancer patients(P<0.001),and the difference was statistically significant.After pin-wise comparison,there was a significant difference in prognosis between the LC-IPF group and the LC combined with IPAF group,and the difference was statistically significant(P<0.01).Cox multivariate analysis showed that increased CRP expression was a risk factor for the prognosis of LC-IPF and LC-IPAF(P=0.045;P=0.017).Tumor type and clinical stage were related factors for survival of patients with LC-IPF(P=0.009;P=0.008),and was also an independent prognostic factor for patients with LC combined with IPAF(P=0.018;P=0.039).The high expression of tumor marker NSE was a factor influencing the poor prognosis of LC combined with CTD-ILD(P=0.027).Conclusions(1)The risk group of LC group,LC-IPF group,LC combined with CTD-ILD group and LC combined with IPAF group were elderly male smokers.Screening of high-risk population should be strengthened..(2)The location of lesion was a significant feature to distinguish the patients in the LC-IPF,LC combined with CTD-ILD group from the LC group.LDH expression level in LC-IPF and LC combined with IPAF was significantly different from that in LC group.In the LC-ILD group,EGFR gene mutation was less in different subgroups,and PD-L1 expression level was not significantly different from that of the LC group.Chemotherapy was the main direction of anti-tumor regimen.(3)ILD is an indepen dent risk factor for prognosis of LC.(4)The prognosis of LC combined with different types of ILD is different,and MDT may be required to be performed with radiologists and pathologists in the future to provide an optimal choice for the formulation of clinical protocols. |
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