摘要：背景：肺癌(LC)對特發性肺纖維化患者的生存有不利影響。然而，對於肺癌在結締組織病相關的間質性肺病(CTD-ILD)患者中的情況目前知之甚少。本研究的目的在於評估CTD-ILD患者中肺癌的患病率和危險因素，以及CTD-ILD患者的臨床特點和生存率。方法：我們對2003年至2016年的CTD-ILD患者進行了單中心回顧性研究。經病理判定患者是否罹患肺癌。觀察肺癌的患病率、危險因素、臨床特點以及對CTD-ILD患者預後的影響。結果：266例CTD-ILD患者中，24例(9.0%)有肺癌。高齡、男性、吸煙、類風濕關節炎病史、普通型間質性肺炎、肺氣腫、肺一氧化碳彌散功能(DLco)低於預測值、未接受免疫抑製治療，都是CTD-ILD患者肺癌的易患因素。多因素分析表明，肺氣腫[比值比(OR值)為8.473%;95%置信區間(CI)，2.241-32.033]和不使用免疫抑製療法(OR，8.111;95%CI，2.457-26.775)是肺癌的獨立危險因素。有肺癌的CTD-ILD患者的生存率顯著低於無肺癌的患者(10年生存率：28.5% vs. 81.8%，P<0.001)。結論：CTD-ILD患者肺癌的發生與肺氣腫及不使用免疫抑製治療有關，肺癌增加了CTD-ILD患者的死亡率。

附原文:Backgrounds: Lung cancer (LC) adversely impacts survival in patients with idiopathic pulmonary fibrosis. However, little is knownabout LC in patients with connective tissue disease-associated interstitial lung disease (CTD-ILD). The aim of this study was to evaluate the prevalence of and risk factors for LC in CTD-ILD, and the clinical characteristics and survival of CTD-ILD patients with LC.Methods: We conducted a single-center, retrospective review of patients with CTD-ILD from 2003 to 2016. Patients with pathologically diagnosed LC were identified. The prevalence, risk factors, and clinical features of LC and the impact of LC on CTD-ILD patients outcomes were observed.Results: Of 266 patients with CTD-ILD, 24 (9.0%) had LC. CTD-ILD with LC was more likely in patients who were older, male, and smokers; had rheumatoid arthritis, a usual interstitial pneumonia pattern, emphysema on chest computed tomography scan, and lower diffusing capacity of the lung carbon monoxide (DLco)% predicted; and were not receiving immunosuppressive therapy. Multivariate analysis indicated that the presence of emphysema [odds ratio (OR), 8.473%; 95% confidence interval (CI), 2.241-32.033] and nonuse of immunosuppressive therapy (OR, 8.111; 95% CI, 2.457-26.775) were independent risk factors for LC. CTD-ILD patients with LC had significantly worse survival than patients without LC (10-year survival rate: 28.5% vs. 81.8%, P<0.001).Conclusions: LC is associated with the presence of emphysema and nonuse of immunosuppressive therapy, and contributes to increased mortality in patients with CTD-ILD.

引自：Satoshi W, Keigo S, Yoko W, et al. Lung cancer in connective tissue disease-associated interstitial lung disease: clinical features and impact on outcomes. Journal of Thoracic Disease, 2018, 10(2): 799-807. DOI: 10.21037/jtd.2017.12.134.