摘要：背景：肺癌(LC)对特发性肺纤维化患者的生存有不利影响。然而，对于肺癌在结缔组织病相关的间质性肺病(CTD-ILD)患者中的情况目前知之甚少。本研究的目的在于评估CTD-ILD患者中肺癌的患病率和危险因素，以及CTD-ILD患者的临床特点和生存率。方法：我们对2003年至2016年的CTD-ILD患者进行了单中心回顾性研究。经病理判定患者是否罹患肺癌。观察肺癌的患病率、危险因素、临床特点以及对CTD-ILD患者预后的影响。结果：266例CTD-ILD患者中，24例(9.0%)有肺癌。高龄、男性、吸烟、类风湿关节炎病史、普通型间质性肺炎、肺气肿、肺一氧化碳弥散功能(DLco)低于预测值、未接受免疫抑制治疗，都是CTD-ILD患者肺癌的易患因素。多因素分析表明，肺气肿[比值比(OR值)为8.473%;95%置信区间(CI)，2.241-32.033]和不使用免疫抑制疗法(OR，8.111;95%CI，2.457-26.775)是肺癌的独立危险因素。有肺癌的CTD-ILD患者的生存率显著低于无肺癌的患者(10年生存率：28.5% vs. 81.8%，P<0.001)。结论：CTD-ILD患者肺癌的发生与肺气肿及不使用免疫抑制治疗有关，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.