Impact and prognosis of lung cancer in patients with combined pulmonary fibrosis and emphysema.

Background Combined pulmonary fibrosis and emphysema (CPFE) is frequently associated with lung cancer. However, the impact and outcomes of lung cancer in patients with CPFE are unclear. Objective We investigated the impact of lung cancer in patients with CPFE in terms of acute exacerbation (AE) and mortality, and identified the mortality predictors of patients with CPFE and lung cancer. Methods We retrospectively reviewed 12-year medical records of patients at the Korea University Guro Hospital. Based on computed tomography findings, we selected CPFE patients with and without lung cancer, and analyzed age, sex, smoking status and history, body mass index, past medical history, pulmonary function, the gender, age, and physiology (GAP) score, AE, and mortality. Results Of 227 CPFE patients, 61 were diagnosed with lung cancer. While 10 of the 61 patients experienced AE, 41 died during the observation period. Lung cancer was a significant predictor of AE (hazard ratio [HR] 3.27, 95% confidence interval [CI ]1.44-7.43, P<0.01) and mortality (HR 4.74, 95% CI 2.55-8.81, P<0.01) in CPFE patients. AE, rather than age, GAP score, or lung cancer stage, was the most significant factor associated with mortality in patients with CPFE and lung cancer (HR 9.20, 95% CI 1.13-74.70, P=0.04). Conclusions Lung cancer has a significant impact on the outcomes of CPFE and is associated with severe complications. AE was the most important mortality predictor in patients with lung cancer combined with CPFE. Therefore, the diagnosis and treatment of lung cancer should be carefully planned in patients with CPFE. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020020).