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Abstract：
BACKGROUND: Interstitial pneumonia and emphysema may complicate patients with lung cancer. However, clinical significance of trivial and mild pulmonary abnormalities remains unclear. In this study, we aimed to investigate whether trivial and mild interstitial pneumonia and emphysema, in addition to their advanced forms, impact the prognosis and lead to acute exacerbation of interstitial pneumonia (AEIP) in patients with lung cancer.
METHODS: This retrospective cohort study was conducted at a tertiary hospital and included patients with lung cancer. Computed tomography images were evaluated using the interstitial lung abnormality (ILA) score for interstitial pneumonia, which included no ILA, equivocal ILA, ILA, interstitial lung disease (ILD), and the Goddard score for emphysema. Cox analyses were performed using the ILA and Goddard scores as the main explanatory variables, adjusting for multiple covariates.
RESULTS: Among 1,507 patients with lung cancer, 1,033 had no ILA, 160 had equivocal ILA, 174 had ILA, and 140 had ILD. In total, 474 patients (31.5%) exhibited interstitial pneumonia and 638 (42.3%) showed emphysema. The log-rank trend test showed that survival probability was significantly better in patients with no ILA, followed by those with equivocal ILA, ILA, and ILD (P < 0.001). After adjustment, the ILA and Goddard scores remained significant variables for increased hazard ratios (HR) for mortality: no ILA (HR, 1.00: reference), equivocal ILA (HR, 1.31; 95% confidence interval [CI], 1.18-1.46; P < 0.001), ILA (HR, 1.71; 95% CI, 1.39-2.12; P < 0.001), ILD (HR, 2.24; 95% CI, 1.63-3.09; P < 0.001), and Goddard score (HR, 1.03; 95% CI, 1.01-1.06; P < 0.010). Moreover, both scores were associated with increased cause-specific HRs for AEIP.
CONCLUSIONS: Our results revealed that approximately one-third of patients with lung cancer had interstitial pneumonia when incorporating trivial and mild cases. Because interstitial pneumonia and emphysema, ranging from trivial to severe, significantly impact mortality and AEIP in patients with lung cancer, we should identify even trivial and mild cases of these pulmonary abnormalities among patients with lung cancer in addition to the advanced ones.
METHODS: This retrospective cohort study was conducted at a tertiary hospital and included patients with lung cancer. Computed tomography images were evaluated using the interstitial lung abnormality (ILA) score for interstitial pneumonia, which included no ILA, equivocal ILA, ILA, interstitial lung disease (ILD), and the Goddard score for emphysema. Cox analyses were performed using the ILA and Goddard scores as the main explanatory variables, adjusting for multiple covariates.
RESULTS: Among 1,507 patients with lung cancer, 1,033 had no ILA, 160 had equivocal ILA, 174 had ILA, and 140 had ILD. In total, 474 patients (31.5%) exhibited interstitial pneumonia and 638 (42.3%) showed emphysema. The log-rank trend test showed that survival probability was significantly better in patients with no ILA, followed by those with equivocal ILA, ILA, and ILD (P < 0.001). After adjustment, the ILA and Goddard scores remained significant variables for increased hazard ratios (HR) for mortality: no ILA (HR, 1.00: reference), equivocal ILA (HR, 1.31; 95% confidence interval [CI], 1.18-1.46; P < 0.001), ILA (HR, 1.71; 95% CI, 1.39-2.12; P < 0.001), ILD (HR, 2.24; 95% CI, 1.63-3.09; P < 0.001), and Goddard score (HR, 1.03; 95% CI, 1.01-1.06; P < 0.010). Moreover, both scores were associated with increased cause-specific HRs for AEIP.
CONCLUSIONS: Our results revealed that approximately one-third of patients with lung cancer had interstitial pneumonia when incorporating trivial and mild cases. Because interstitial pneumonia and emphysema, ranging from trivial to severe, significantly impact mortality and AEIP in patients with lung cancer, we should identify even trivial and mild cases of these pulmonary abnormalities among patients with lung cancer in addition to the advanced ones.
摘要：
背景：间质性肺炎和肺气肿可能会使肺癌患者复杂化。然而,轻微和轻度肺部异常的临床意义尚不清楚.在这项研究中,我们的目的是调查是否轻微和轻度间质性肺炎和肺气肿，除了它们的先进形式，间质性肺炎(AEIP)会影响肺癌患者的预后并导致其急性加重。
方法：本回顾性队列研究在三级医院进行，纳入肺癌患者。使用间质性肺异常（ILA）评分评估间质性肺炎的计算机断层扫描图像，其中不包括ILA，模棱两可的ILA,ILA,间质性肺病（ILD），还有Goddard的肺气肿评分.Cox分析使用ILA和Goddard分数作为主要解释变量，调整多个协变量。
结果：在1,507例肺癌患者中，1,033没有ILA，160有模棱两可的ILA，174有ILA，140人患有ILD。总的来说,474例患者（31.5％）出现间质性肺炎，638例（42.3％）出现肺气肿。对数秩趋势检验显示，无ILA患者的生存概率明显更好，紧随其后的是那些模棱两可的ILA，ILA,和ILD（P<0.001）。调整后,ILA和戈达德得分仍然是死亡率风险比(HR)增加的显著变量：无ILA(HR，1.00：参考），模棱两可的ILA(HR，1.31；95%置信区间[CI]，1.18-1.46；P<0.001），ILA(HR,1.71；95%CI，1.39-2.12；P<0.001），ILD(HR,2.24；95%CI，1.63-3.09；P<0.001），和戈达德得分(HR，1.03；95%CI，1.01-1.06；P<0.010）。此外，两个评分均与AEIP的病因特异性HR增加相关.
结论：我们的结果显示，大约三分之一的肺癌患者在合并轻微和轻度病例时患有间质性肺炎。因为间质性肺炎和肺气肿,从琐碎到严重，显着影响肺癌患者的死亡率和AEIP，除了晚期肺癌，我们应该在肺癌患者中识别这些肺部异常的轻微病例。
方法：本回顾性队列研究在三级医院进行，纳入肺癌患者。使用间质性肺异常（ILA）评分评估间质性肺炎的计算机断层扫描图像，其中不包括ILA，模棱两可的ILA,ILA,间质性肺病（ILD），还有Goddard的肺气肿评分.Cox分析使用ILA和Goddard分数作为主要解释变量，调整多个协变量。
结果：在1,507例肺癌患者中，1,033没有ILA，160有模棱两可的ILA，174有ILA，140人患有ILD。总的来说,474例患者（31.5％）出现间质性肺炎，638例（42.3％）出现肺气肿。对数秩趋势检验显示，无ILA患者的生存概率明显更好，紧随其后的是那些模棱两可的ILA，ILA,和ILD（P<0.001）。调整后,ILA和戈达德得分仍然是死亡率风险比(HR)增加的显著变量：无ILA(HR，1.00：参考），模棱两可的ILA(HR，1.31；95%置信区间[CI]，1.18-1.46；P<0.001），ILA(HR,1.71；95%CI，1.39-2.12；P<0.001），ILD(HR,2.24；95%CI，1.63-3.09；P<0.001），和戈达德得分(HR，1.03；95%CI，1.01-1.06；P<0.010）。此外，两个评分均与AEIP的病因特异性HR增加相关.
结论：我们的结果显示，大约三分之一的肺癌患者在合并轻微和轻度病例时患有间质性肺炎。因为间质性肺炎和肺气肿,从琐碎到严重，显着影响肺癌患者的死亡率和AEIP，除了晚期肺癌，我们应该在肺癌患者中识别这些肺部异常的轻微病例。
