OPA4 A COMPLEX DUO: UNVEILING LUNG CANCER IN INTERSTITIAL LUNG DISEASE

Chen Yong Tan1, Thian Hao Ho2, Shoban Raj Vasudayan1, Sumithra Appava1, Yen Shen Wong1, Normaszuhaila Abd Hamid2, Aishah Sulaiman2, Noorul Afidza Muhammad1, Syazatul Syakirin Sirol Aflah2
1Hospital Sultan Idris Shah, Serdang, Malaysia
2Institut Perubatan Respiratori, Kuala Lumpur, Malaysia

Introduction:

The incidence of lung cancer in interstitial lung disease patients (LC-ILD), particularly idiopathic pulmonary fibrosis (IPF), is rising, predominantly affecting men and smokers, contributing to poorer outcomes and survival.

Methodology:

This retrospective cross-sectional study reviewed LC-ILD patient medical records from two Klang Valley respiratory centres over a decade.

Findings:

Fourteen LC-ILD patients, evenly split between IPF and non-IPF groups, were predominantly male (85.7%) and smokers (71.4%), with a median age at ILD diagnosis of 65 years (interquartile range, IQR, 48-73 years). Half showed usual interstitial pneumonia (UIP) radiologic patterns, primarily in the IPF subgroup. The majority (85.7%) were diagnosed with primary lung malignancies, often found in the right lung (71.4%), upper lobe (57.1%), and periphery (92.9%). Adenocarcinoma comprised 50%, with one case harbouring anaplastic lymphoma kinase (ALK) mutations and none with epidermal growth factor receptor (EGFR) mutations. Treatment included chemotherapy (21.4%), surgical resection (7.1%), and palliative care alone (64.3%), with antifibrotic treatment initiated in two patients (14.3%). Over half (57.1%) succumbed to illness, with median survivals from ILD and cancer diagnoses of 9.5 months (range 2.5-39.0 months) and 2.5 months (range 1.3-9.0 months), respectively.

Discussion:

Contrary to previous literature, our study found that LC-IPF occurred more frequently in the upper lobes, despite UIP predominance. Adenocarcinoma was more prevalent than squamous cell carcinoma. Patients with ILD encounter distinct challenges in LC care; effective treatment can notably enhance survival, highlighting the role of multidisciplinary care.

Conclusion:

Close monitoring for symptom exacerbation and vigilant evaluation of imaging findings are essential for early detection, timely intervention, and optimizing outcomes in LC-ILD patients.