Clinical characteristic of 56 cases with lung cancer in patients with connective tissue disease / 中华风湿病学杂志

ABSTRACT

Objective:To improve the understanding of patients with connective tissue diseases(CTD) associated with lung cancer.Methods:The clinical manifestations of in-patients diagnosed as CTD associated with lung cancer in our center from January 2011 to May 2022 were retrospectively analyzed,including demographic information,pathological classification of lung cancer,TNM stage,the time sequence of the diagnosis of CTD and lung cancer, treatment and clinical outcomes. The mean±standard deviation was used for the numeric variables and the number of cases (%) was used in the counting data. Fifty patients were cofirmed to have squamous cell carcinoma, adenocarcinoma and small-cell carcinoma group. Chi-square test was used to compare the differences between groups.Results:Fifty-six patients with CTD were complicated with lung cancer, of whom 27 were male, and 29 were female. The age of CTD at diagnosis was (58±15) years. The age of lung cancer at diagnosis was (69±10) years. Of patients with CTD, rheumatoid arthritis was the most common type of rheumatic disease, followed by polymyositis/dermatomyositis, systemic sclerosis and systemic lupus erythematosus. Of patients with CTD, 24 cases (42.9%) had interstitial pulmonary disease. Of patients with lung cancer, mass ( n=26, 46.4%) was the most common initial presentation, followed by cough and expectoration ( n=19, 33.8%). Non small cell lung cancer, the most common pathological type, was found in 47 cases (83.9%), followed by small cell lung cancer in 6 cases(10.7%). Stage Ⅳ was the most common stage in 36 cases(65.5%) by TNM staging. The diagnosis of CTD was earlier than that of lung cancer in 42 cases (42/56), with an median of 90 (45, 244) months, ranged between 7 months and 50 years. The diagnosis of lung cancer was earlier than that of CTD in 2 cases (2/56), with the interval of 7 and 15 months respecticely. Twelve cases (12/56) were diagnosed with CTD at the same time, and the interval between CTD and lung cancer was within 6 months. Fifty-five patients were followed up with an median of 10 (2, 24) months. In 15 patients (26.8%) with stable conditions, stageⅠ( n=10, 66.7%) cancer was the most common stage, followed by stage Ⅱ( n=2, 13.3%). Thirty-seven patients (66.1%) died of end stage lung cancer ( n=21, 56.8%) or infection ( n=16, 43.2%). The most lethal was stage Ⅳ ( n=32, 86.5%) lung cancer. There were significant differences in sex [male 9 cases (90.0%), 13 cases (38.2%) vs 4 cases (66.7%), χ2=8.88, P=0.012], smoking [8 cases (80.0%), 11 cases (32.4%) vs 4 cases (66.7%), χ2=8.24, P=0.016] and TNM stage [stage I for 0 case (0), 12 cases(35.3%) vs 0 case (0), stage Ⅱ-Ⅲ for 4 cases (40.0%), 3 cases (8.8%) vs 0 cases (0), stage Ⅳ for 6 cases (60.0%), 19 cases (55.9%) vs 6 cases (100%), χ2=13.58, P=0.009] among squamous cell carcinoma, adenocarcinoma and small-cell carcinoma groups. Conclusion:The prognosis of patients with CTD complicated with lung cancer is poor and the mortality rate is high. Therefore, close follow-up and regularly imaging are necessary for CTD patients.