title: The histological characteristics and clinical outcomes of lung cancer in patients with combined pulmonary fibrosis and emphysema.
abstract: Combined pulmonary fibrosis and emphysema (CPFE) is an important risk factor for lung cancer (LC), because most patients with CPFE are smokers. However, the histological characteristics of LC in patients with CPFE (LC-CPFE) remain unclear. We conducted this study to explore the clinicopathological characteristics of LC-CPFE. We retrospectively reviewed data from 985 patients who underwent resection for primary LC, and compared the clinicopathological characteristics of patients with LC-CPFE and non-CPFE LC. We identified 72 cases of LC-CPFE, which were significantly associated with squamous cell carcinoma (SqCC) histology (n = 46, P < 0.001) and higher tumor grade (n = 44, P < 0.001), compared to non-CPFE LC. Most LC-CPFE lesions were contiguous with fibrotic areas around the tumor (n = 59, 81.9%), and this association was independent of tumor location. Furthermore, dysplastic epithelium was identified in the fibrotic area for 31 (52.5%) LC-CPFE lesions. Moreover, compared to patients with pulmonary fibrosis alone in the non-CPFE group (n = 31), patients with CPFE were predominantly male (P = 0.008) and smokers (P < 0.001), with LC-CPFE predominantly exhibiting SqCC histology (P = 0.010) and being contiguous with the tumor-associated fibrotic areas (P < 0.001). Multivariate analysis revealed that CPFE was an independent predictor of overall survival (hazard ratio: 1.734; 95% confidence interval: 1.060-2.791; P = 0.028). Our results indicate that LC-CPFE has a distinct histological phenotype, can arise from the dysplastic epithelium in the fibrotic area around the tumor, and is associated with poor survival outcomes.
authors.affiliation: Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Meng
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan. akyoshi@kuhp.kyoto-u.ac.jp.|Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan. akyoshi@kuhp.kyoto-u.ac.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Yoshizawa
authors.affiliation: Department of Radiology, Shinshu University Hospital, Matsumoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kawakami
authors.affiliation: Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.
authors.forename: Shiho
authors.initials: S
authors.lastname: Asaka
authors.affiliation: First Department of Internal Medicine, Shinshu University Hospital, Matsumoto, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamamoto
authors.affiliation: First Department of Internal Medicine, Shinshu University Hospital, Matsumoto, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Yasuo
authors.affiliation: Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Agatsuma
authors.affiliation: Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Toishi
authors.affiliation: Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Shiina
authors.affiliation: Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, Japan.|Department of Thoracic Surgery, Suwa Red Cross Hospital, Suwa, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yoshida
authors.affiliation: Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Honda
authors.affiliation: Division of Breast, Endocrine and Respiratory Surgery, Department of Surgery (II), Shinshu University School of Medicine, Matsumoto, Japan.
authors.forename: Ken-Ichi
authors.initials: KI
authors.lastname: Ito
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000209:etiology / Q000473:pathology*; D018572:Disease-Free Survival; D004646:Emphysema / Q000150:complications*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011658:Pulmonary Fibrosis / Q000150:complications*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D016019:Survival Analysis
keywords: Combined pulmonary fibrosis and emphysema (CPFE); histology; lung cancer; prognosis; pulmonary fibrosis