• Atsushi Miyamoto, Atsuko Kurosaki, Shuhei Moriguchi, Yui Takahashi, Kazumasa Ogawa, Kyoko Murase, Shigeo Hanada, Hironori Uruga, Hisashi Takaya, Nasa Morokawa, Takeshi Fujii, Junichi Hoshino, and Kazuma Kishi.
• Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo 105-8470, Japan. Electronic address: atsushimotty@gmail.com.
• Respir Investig. 2019 Mar 1; 57 (2): 140-149.

BackgroundThis study aimed to determine the radiologic predictors and clarify the clinical features related to survival in patients with combined pulmonary fibrosis and emphysema (CPFE) and lung cancer.MethodsWe retrospectively reviewed the medical chart data and high-resolution computed tomography (HRCT) findings for 81 consecutive patients with CPFE and 92 primary lung cancers (70 men, 11 women; mean age, 70.9 years). We selected 8 axial HRCT images per patient, and visually determined the normal lung, modified Goddard, and fibrosis scores. Multivariate analysis was performed using the Cox proportional hazards regression model.ResultsThe major clinical features were a high smoking index of 54.8 pack-years and idiopathic pulmonary fibrosis (n = 44). The major lung cancer profile was a peripherally located squamous cell carcinoma (n = 40) or adenocarcinoma (n = 31) adjacent to emphysema in the upper/middle lobe (n = 27) or fibrosis in the lower lobe (n = 26). The median total normal lung, modified Goddard, and fibrosis scores were 10, 8, and 8, respectively. TNM Classification of malignant tumors (TNM) stage I, II, III, and IV was noted in 37, 7, 26, and 22 patients, respectively. Acute exacerbation occurred in 20 patients. Multivariate analysis showed that a higher normal lung score and TNM stage were independent radiologic and clinical predictors of poor survival at the time of diagnosis of lung cancer.ConclusionsA markedly reduced area of normal lung on HRCT was a relevant radiologic predictor of survival.Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

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