Friday, August 30, 2013

Emphysema does not aggravate lung cancer prognosis beyond pulmonary fibrosis

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Emphysema does not aggravate lung cancer prognosis beyond pulmonary fibrosis -

By Sarah Pritchard, medwireNews Reporter

The fibrosis patients combined lung and emphysema (CSPS) who are undergoing treatment for advanced lung cancer does not have a prognosis significantly less than their counterparts with isolated idiopathic interstitial pneumonia (IIP), Japanese researchers report.

Indeed, the results of their study show that age, performance status of cancer (PS), the percentage predicted forced vital capacity (VC%, indicating lung function) and serum lactate dehydrogenase (LDH; an pneumocytes marker damaged). are the most significant predictors of poor prognosis, rather than the presence of emphysema or given type of treatment

results did not confirm the initial hypothesis of the team that "can indicate CSPS a significantly increased risk of lung cancer than either chronic obstructive pulmonary disease or a single isolated pulmonary fibrosis. "

researchers, led by Yugi Minegishi, Nippon Medical School in Tokyo, retrospectively reviewed the medical records of lung cancer patients with IIP 151, including 58.3% met criteria for CSPS on CT . While the rate of idiopathic pulmonary fibrosis was similar between CpFe and not CpFe patients, 54.5% and 61.3%, respectively, those who had a significantly CSPS fibrosis score and a reduced percentage significantly predicted capacity lung diffusion for carbon monoxide.

patients were classified as having an acute exacerbation (AE) of IIP if they had an exacerbation of dyspnea in a month, newly developed diffuse lung opacities on the analyzes of the breast, decreased arterial oxygen tension of more than 10 mmHg and no heart failure or pulmonary infectious diseases.

Although there was no difference in the type of CpFe treatment and non-CpFe patients had initially AE was higher in the CSPS than non-patients undergo CpFe surgery and the best support care (26.9 vs 15.8%, and 45.0 vs 18.2%, respectively).

In addition, the median overall survival was not significantly different depending on the status of emphysema, 23.7 months and 20.3 months for patients not CpFe CpFe respectively. However, this trend was reversed among those who received chemotherapy as first-line treatment, with a respective 14.8 compared to 21.6 months.

Multivariate analysis revealed that age over 68 years, a PS of 1-3 against Eastern Cooperative Oncology Group 0,% VC less than 80% and a level of at least 244 IU / L of LDH significantly predicted poor prognosis with ratios 1.1, 3.8, 3.2 and 2.8, respectively hazard.

Minegishi and colleagues believe that their findings indicate that pulmonary fibrosis, but not emphysema, may affect lung cancer prognosis CSPS, and this, as well as isolated IIP can work through similar mechanisms for AE.

"Therefore, we conclude that it is not necessary to adjust the treatment strategy for lung cancer with IPI for the existence of emphysema at this time," they wrote in lung cancer .

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