title: Prognostic significance of preexisting interstitial lung disease in Japanese patients with small-cell lung cancer.
abstract: We retrospectively investigated patients with small-cell lung cancer with or without interstitial lung disease (ILD). Response rates and median progression-free survival of first-line chemotherapy in patients with or without preexisting ILD was not significantly different. However, pneumonitis associated with chemotherapy was significantly increased in patients with preexisting ILD, and preexisting ILD is an independent prognostic factor for poorer survival.
  
  
  BACKGROUND
  In Japan, iatrogenic acute exacerbation of interstitial lung disease (ILD) is a serious complication in patients with lung cancer and simultaneous ILD. Results of some reports suggest that patients with ILD and small-cell lung cancer (SCLC) might benefit from chemotherapy, but the influence of ILD on prognosis is unclear.
  
  
  METHODS
  Retrospective study of patients with SCLC with or without ILD. Between April 2006 and March 2011, 122 patients with SCLC who were receiving platinum-based combination chemotherapy participated.
  
  
  RESULTS
  Twenty-eight patients (23.0%) had ILD at diagnosis. Pneumonitis associated with chemotherapy, including acute exacerbation-ILD was significantly increased in patients with preexisting ILD (8/28 vs. 2/94; P = .0001). In patients receiving chemotherapy alone, response rates and median progression-free survival of first-line chemotherapy in patients with or without preexisting ILD was not significantly different (P = .26; 20/26 vs. 52/60 and P = .089; 4.4 months vs. 5.4 months, respectively). The median overall survival of all patients was 15.5 months, but those without preexisting ILD survived significantly longer (P = .0010; 17.8 months vs. 10.7 months). Multivariate analysis revealed that performance status of 0 or 1 (hazard ratio [HR] 0.19 [95% confidence interval {CI}, 0.10-0.37]; P < .0001) limited disease (HR 0.42 [95% CI, 0.23-0.73]; P = .0017), and no preexisting ILD (HR 0.36 [95% CI, 0.19-0.69]; P = .0027) were significantly associated with longer overall survival.
  
  
  CONCLUSIONS
  Patients with SCLC and ILD might benefit from chemotherapy, but preexisting ILD is an independent prognostic factor for poorer survival.
authors.affiliation: Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. ytogashi@kuhp.kyoto-u.ac.jp
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Togashi
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Masago
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Handa
authors.forename: Kiminobu
authors.initials: K
authors.lastname: Tanizawa
authors.forename: Chiyuki
authors.initials: C
authors.lastname: Okuda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sakamori
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nagai
authors.forename: Young Hak
authors.initials: YH
authors.lastname: Kim
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications; D007564:Japan; D017563:Lung Diseases, Interstitial / Q000150:complications*; D008175:Lung Neoplasms / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D011379:Prognosis; D012189:Retrospective Studies; D055752:Small Cell Lung Carcinoma / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy; D015996:Survival Rate
chemical_list: D000970:Antineoplastic Agents