| Institution: | 1. Department of Respiratory Medicine, Respiratory Centre, Toranomon Hospital, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan;2. School of Pharmacy, Department of Clinical Medicine (Biostatistics), Kitasato University, 5-9-1 Shirokane Minato-ku, Tokyo, 108-8642, Japan;3. Department of Respiratory Medicine, National Hospital Organization, Himeji Medical Centre, 68 hon-machi Himeji-shi, Hyogo, 670-8520, Japan;4. Department of Respiratory Medicine, National Hospital Organization, Tokyo National Hospital; 3-1-1 Takeoka Kiyose-shi, Tokyo, 204-8585, Japan;5. Department of Respiratory Medicine, Japanese Red Cross Osaka Hospital, 5-30 Fudegasakicho, Tennoji-ku, Osaka 543-8555, Japan;6. Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School University, 1-1-5 Sendagi Bunkyo-ku Tokyo, 113-8602, Japan;7. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Centre, 6-16-1 Tomioka-higashi Kanazawa-ku Yokohama-shi, Kanagawa, 236-0051, Japan;8. Department of Respiratory Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8521, Japan;9. Department of Thoracic Surgery, Kyoto University Graduate School of Medicine, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan;10. Department of Respiratory Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo Bunkyo-ku, Tokyo, 113-8421, Japan;11. Department of Respiratory Medicine, Toho University Graduate School of Medicine, 6-11-1 Omori-Nishi Ota-ku, Tokyo, 143-8541, Japan;12. Okinaka Memorial Institute for Medical Research, 2-2-2 Toranomon Minato-ku, Tokyo, 105-8470, Japan |
| Abstract: | BackgroundThe clinical questions of whether chemotherapy as initial treatment, compared with best supportive care (BSC), improves overall survival (OS) and whether it increases the occurrence risk of acute exacerbation of idiopathic interstitial pneumonia (IIP) in patients with advanced-stage lung cancer and IIP remain inconclusive. This study addresses these issues, given that chemotherapy-related acute exacerbation of IIP may be a direct cause of mortality in these patients.MethodsWe enrolled 1003 patients from 110 Japanese institutions and collected clinical profiles from 707 and 296 patients in the chemotherapy (men: women, 645:62; mean age, 70.4 ± 6.9 years) and BSC (men: women, 261:35; mean age, 75.2 ± 7.8) groups, respectively. We used propensity score matching to create 222 matched pairs from both groups using patient demographic data (age, sex, smoking status, performance status, history of acute exacerbation of IIP, desaturation on exertion, clinical diagnosis of IIP, high-resolution computed tomography findings, serum fibrotic markers, pulmonary function status, and lung cancer histopathology). Logistic or Cox regression analyses were performed using matched data to assess the effects of chemotherapy on the risk of acute exacerbation of IIP or OS, respectively.ResultsIn the well-matched cohort, chemotherapy improved OS (hazard ratio: 0.629, 95% confidence interval CI]: 0.506–0.783, p < 0.0001); however, it involved significant acute exacerbation of IIP (odds ratio: 1.787, 95% CI: 1.026–3.113) compared to BSC.ConclusionsCompared with BSC, chemotherapy can improve OS in patients with advanced-stage lung cancer and IIP; however, it increases the risk of acute exacerbation of IIP. |
