Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Acute Exacerbation of Idiopathic Pulmonary Fibrosis with Lung Cancer: A Comparative Analysis of the Incidence, Survival Rate, and CT Findings with the Patients without Lung Cancer

폐암을 동반한 특발성 폐섬유증 환자에서 폐섬유증의 급성 악화: 폐암 비동반군과의 발병률, 생존율 및 전산화단층촬영 소견의 비교

  • Bumsang Cho (Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Hee Kang (Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Je Hun Kim (Department of Pulmonary and Critical Care Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Jung Gu Park (Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Sekyoung Park (Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Jong Hyouk Yun (Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • 조범상 (고신대학교 의과대학 고신대학교 복음병원 영상의학과) ;
  • 강희 (고신대학교 의과대학 고신대학교 복음병원 영상의학과) ;
  • 김제훈 (고신대학교 의과대학 고신대학교 복음병원 호흡기 및 중환자 의학과) ;
  • 박정구 (고신대학교 의과대학 고신대학교 복음병원 영상의학과) ;
  • 박세경 (고신대학교 의과대학 고신대학교 복음병원 영상의학과) ;
  • 윤종혁 (고신대학교 의과대학 고신대학교 복음병원 영상의학과)
  • Received : 2019.05.28
  • Accepted : 2019.09.03
  • Published : 2020.05.01
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Abstract

Purpose To compare the incidence, survival rate, and CT findings of acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) between patients with and without lung cancer. Materials and Methods From June 2004 to July 2018, 89 consecutive patients diagnosed with IPF were included. Among them, 26 patients had IPF with lung cancer (IPF-LCA), and 63 patients had IPF alone. The clinical characteristics and CT findings associated with IPF, lung cancer, and AE were reviewed. Surgery and chemotherapy were performed for 6 and 23 cases of lung cancer, respectively, as the first- or second-line anticancer treatment. The overall survival, CT findings, disease-free period before AE, and duration from the onset of AE to death were compared. Results The incidence of AE was 61.5% in the IPF-LCA group and 58.7% in the IPF group (p = 0.806). The mean overall survival in the IPF-LCA and IPF groups were 16.8 and 83.0 months, respectively (p < 0.001). The mean durations from the start of the lung cancer treatment to the onset of AE were 16.0 and 4.6 months in cases of surgical treatment and chemotherapy, respectively. In comparison of death from AE, the survival rate was significantly lower in the IPF-LCA group than in the IPF group (p = 0.008). In the CT findings associated with AE, the IPF-LCA group tended to have a peribronchial (p < 0.001) or asymmetric distribution (p = 0.016). Conclusion In patients with IPF who develop lung cancer, the rate of death from AE is higher than that in patients with IPF alone. They tend to have unusual CT patterns associated with AE, such as a peribronchial or asymmetric distribution.

목적 폐암이 동반된 특발성 폐섬유증 환자와 폐암 비동반 특발성 폐섬유증 환자에서 폐섬유증 급성 악화의 발병률, 생존율 및 전산화단층촬영 소견을 비교하고자 하였다. 대상과 방법 2004년 6월부터 2018년 7월까지, 특발성 폐섬유증으로 진단받은 89명의 환자를 대상으로 하였으며 26명의 폐암 동반 특별 폐섬유증 환자군과 63명의 폐암 비동반 특발 폐섬유증 환자군으로 구성되었다. 이들의 폐섬유증, 폐암, 급성 악화와 관련된 임상 검사 소견과 CT 소견을 검토하였다. 폐암 환자들은 1차 또는 2차 치료로 수술(n = 6), 항암치료(n = 23) 등을 받았다. 두 군 간에 생존율, 급성 악화의 CT 소견, 무병 기간과 급성 악화 발병 이후 사망까지의 시간을 비교하였다. 결과 급성 악화의 발병률은 폐암 동반군에서는 61.5%, 비동반군에서는 58.7%였다(p = 0.806). 폐암 동반군과 비동반군의 평균 생존 기간은 각각 16.8개월과 83.0개월이었다(p < 0.001). 치료 시작부터 급성 악화까지의 기간은 수술과 항암치료에서 각각 16.0개월과 4.6개월이었다. 급성 악화에 의한 사망을 비교하였을 때, 생존율은 폐암 동반군이 비동반군보다 유의하게 낮았다(p = 0.008). 급성 악화의 CT 소견은 폐암 동반군에서 기관지 주위 분포(p < 0.001)와 비대칭 분포(p = 0.016)를 보이는 경우가 많았다. 결론 폐암을 동반한 특발성 폐섬유증 환자에서, 급성 악화에 의한 사망률이 폐암 비동반 특발 폐섬유증 환자들보다 높았다. 또한, 기관지 주위 또는 비대칭 분포의 CT 소견을 보이는 경향이 있다.

Keywords

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