Clinical Research Of Combined Pulmonary Fibrosis And Emphysema Syndrome With Lung Cancer

Objective: To investigate the clinical characteristics of combined pulmonary fibrosis and emphysema syndrome with lung cancer(CPFE-LC),and to further introduce and analyze the characteristics of the disease by comparing with the medical records of CPFE and LC patients.Methods: The medical records of 43 CPFE-LC patients from First Affiliated Hospital of Dalian Medical University were reviewed,and the mechanism of imaging features,pathophysiology and heredity were analyzed in CPFE-LC patients.Added the medical records of 13 CPFE-LC patients from Second Affiliated Hospital of Dalian Medical University,a total of 56 cases,were compared with 75 cases of CPFE without lung cancer and 75 cases of simple lung cancer from first affiliated hospital at the same time.Results: 1.40 cases of CPFE-LC were male and only three were women.The oldest age is 83 and the youngest is 54.34(79.1%)cases had a history of smoking,19 cases(44.2%)had common chronic diseases.Chest HRCT showed that 43 patients with pulmonary fibrosis mainly showed grid shadow(67.4%),and pulmonary emphysema is more common in the interlobular area.Lung tumors mostly showed mass shadow(51.2%).19 cases had lung function tests and the predictive value of FEV1%(percentage of forced expiratory volume in 1 second)was 86.15%±15.84%,FEV1/FVC%(percentage of rate in the first second)was 77.86%±7.76%,the predictive value of FEV1/FVC% was 98.90%±14.53%,the DLco(carbon monoxide diffusion capacity)was(8.72±6.31)mmol·min-1·k Pa-1 and the predictive value of DLco% was 64.89%±18.41%.2.The symptoms of shortness of breath was obvious in CPFE-LC group compared with CPFE group.Compared with LC group,the symptoms of cough,expectoration,fatigue and low fever in CPFE-LC group were significantly different(P<0.05).The rate of one second in CPFE-LC was lower than that in CPFE group,and the Lung diffusion function showed mild to moderate disorder in these two groups.And there was not statistically significant when compared with LC group.3.The proportion of squamous cell carcinoma in the CPFE-LC group was similar to that in the LC group(37.5% vs 30.7%),and the proportion of adenocarcinoma was lower than that in LC group(48.2% vs 61.3%).There was no significant difference in tumor classification and distribution between them.When compared tumor staging in the CPFELC group and LC group,there were 7 cases and 18 cases(12.5% vs 24.0%)in I period,4 cases and 24 cases(7.1% vs 32.0%)in II period,24 cases and 27 cases(42.9% vs 36.0%)in III period,and 21 cases and 6 cases(37.5% vs 8.0%)in IV period.By chi-square test,P=0.000013,and the difference was statistically significant(less than 0.01).In the CPFELC group,more tumors involved lymph nodes(66.1% vs 33.3%,P<0.05).4.During the 3-year follow-up period,18 cases(32.1%)of the CPFE-LC group and 5 cases(6.7%)of the LC group occurred death events(P=0.00015).In the CPFE group,9 patients(12.0%)died.(P=0.005,all P < 0.01).Conclusion: 1.The pulmonary ventilation function in CPFE patients is almost normal,and is caused by the type,distribution,pathophysiological characteristics of emphysema and fibrosis,while the lung diffusion function is doubly impaired.In addition,patients with more fibrosis have a worse prognosis than those with emphysema.2.Compared with LC,patients with CPFE were often diagnosed with advanced stage,and tumors were more likely to occur in the lower lobe of the lung and in fibrotic areas.In the past,squamous cell carcinoma was the most common type of CPFE-LC,but in recent years,the proportion of adenocarcinoma in lung cancer has been increasing,which is related to the increasing proportion of female lung cancer patients,the change of smoking habits,cigarette composition and smoking mode,etc.3.Since few patients did lung biopsy for a definite diagnosis of CPFE,the diagnosis relies mainly on the chest HRCT.On this basis,we can use comprehensive physical index,total fibrosis score,gender-age-physiological index and risk stratification score to quantify the degree of fibrosis lesions damage or combined with pulmonary diffusion function to assist the diagnosis.4.CPFE,especially CPFE-LC,is rare in clinic,and has not been widely diagnosed at present,so we should further improve the understanding of patients and doctors.5.The incidence of CPFE is low,but the probability of complicated lung cancer is high,and the possibility of metastasis is high,the therapeutic effect is not good,and the total survival time is short.When suspicious lesions appear on CT or lung diffusion function is significantly reduced,relevant monitoring and closer follow-up should be taken,and appropriate treatment measures should be provided if necessary.