Interstitial lung abnormalities in treatment-naïve advanced non-small-cell lung cancer patients are associated with shorter survival.
OBJECTIVE
Interstitial lung diseases are associated with increased risk of lung cancer. The prevalence of ILA at diagnosis of advanced non-small-cell lung cancer (NSCLC) and its impact on overall survival (OS) remain to be investigated.


METHODS
The study included 120 treatment-naïve stage IV NSCLC patients (53 males, 67 females). ILA was scored on CT prior to any systemic therapy using a 4-point scale [0=no evidence of ILA, 1=equivocal for ILA, 2=suspicious for ILA, 3=ILA] by a sequential reading method previously reported. ILA scores of 2 or 3 indicated the presence of ILA.


RESULTS
ILA was present in 17 patients (14%) with advanced NSCLC prior to any treatment (score3: n=2, score2: n=15). These 17 patients were significantly older (median age: 69 vs. 63, p=0.04) and had a heavier smoking history (median: 40 vs. 15.5 pack-year, p=0.003) than those with ILA score 0 or 1. Higher ILA scores were associated with shorter OS (p=0.001). Median OS of the 17 patients with ILA was 7.2 months [95%CI: 2.9-9.4] compared to 14.8 months [95%CI: 11.1-18.4] in patients with ILA score 0 or 1 (p=0.002). In a multivariate model, the presence of ILA remained significant for increased risk for death (HR=2.09, p=0.028) after adjusting for first-line systemic therapy (chemotherapy, p<0.001; TKI, p<0.001; each compared to no therapy) and pack years of smoking (p=0.40).


CONCLUSIONS
Radiographic ILA was present in 14% of treatment-naïve advanced NSCLC patients. Higher ILA scores were associated with shorter OS, indicating that ILA could be a marker of shorter survival in advanced NSCLC.
Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA; Department of Imaging, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA. Electronic address: Mizuki_Nishino@DFCI.HARVARD.EDU.
Mizuki
M
Nishino
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
Stephanie
S
Cardarella
Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
Suzanne E
SE
Dahlberg
Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
Tetsuro
T
Araki
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
Christine
C
Lydon
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
David M
DM
Jackman
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
Michael S
MS
Rabin
Department of Radiology, Brigham and Women's Hospital, 75 Francis St., Boston, MA 02115, USA.
Hiroto
H
Hatabu
Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215.
Bruce E
BE
Johnson
D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011857:Radiographic Image Interpretation, Computer-Assisted; D012907:Smoking / Q000401:mortality*; D014057:Tomography, X-Ray Computed
Advanced non-small-cell lung cancer; Computed tomography; Interstitial lung disease; Lung cancer; Survival