Lung cancer in patients with idiopathic pulmonary fibrosis: A retrospective multicentre study in Europe
Τheodoros Karampitsakos, Paolo Spagnolo, Nesrin Moğulkoç, Wim Wuyts, Sara Tomassetti, Elisabeth Bendstrup, María Molina‐Molina, Effrosyni D. Manali, Ömer Selim Unat, Francesco Bonella, Nicolas Kahn, Lykourgos Kolilekas, Elisabetta Rosi, Leonardo Gori, Claudia Ravaglia, Venerino Poletti, Zoe Daniil, Thomas Skovhus Prior, Ιlias Papanikolaou, Samantha Aso, Stavros Τryfon, Despoina Papakosta, Vasillios Tzilas, Elisabetta Balestro, Spyridon Papiris, Κατερίνα Αντωνίου, Demosthenes Bouros, Athol U. Wells, Michael Kreuter, Argyris Tzouvelekis
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.