Deleterious impact of trivial to severe pulmonary fibrosis and emphysema on mortality and acute lung injury in patients with lung cancer

<bold>Background and Objective:</bold> Pulmonary fibrosis and emphysema may complicate patients with lung cancer. This study aimed to investigate whether the extent of pulmonary fibrosis and emphysema impacts mortality and acute lung injury (ALI) in patients with lung cancer. The interaction between pulmonary fibrosis and emphysema on these outcomes was also evaluated. <bold>Methods:</bold> This retrospective cohort study was conducted at a tertiary hospital for patients with lung cancer. Computed tomography images were evaluated using the interstitial lung abnormality (ILA) score for pulmonary fibrosis, which indicated no ILA, equivocal ILA, ILA, and interstitial lung disease (ILD), and the Goddard score for emphysema. Cox analyses were performed with the ILA and Goddard scores as the main explanatory variables, including interaction terms and adjustment for covariates. <bold>Results:</bold> Among the 1507 patients with lung cancer, 1033 had no ILA, 160 had equivocal ILA, 174 had ILA, and 140 had ILD. The log-rank trend test revealed that survival was significantly better for patients with no ILA, followed by those with equivocal ILA, ILA, and ILD (P<0.001). After adjustment, the ILA and Goddard scores remained significant variables for increased hazard ratios of mortality in Cox analyses. Moreover, a significant interaction between the ILA and Goddard scores was observed. Additionally, both scores were associated with increased cause-specific hazard ratios for ALI. <bold>Conclusion:</bold> The results of this study suggest that the extent of pulmonary fibrosis and emphysema, ranging from trivial to severe, significantly impacts and interacts with mortality and ALI in patients with lung cancer.