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A6421 - Characteristics of Primary Lung Malignancy in Fibrosis Patients with and Without Lung Transplantation
Author Block: E. Gershman; Pulmonary DIvision, Rabin Medical Center, Petah Tikva, Israel.
Charecteristics of primary lung malignancy in IPF patients with and without lung transplantation
Evgeni Gershman 1,3, Dror Rosengarten1,3, Benjamin D. Fox1,3, Nader Abdel Rahman1,3, Nir Peled 2,3, Mordechai R. Kramer1,3 1Pulmonary Division , Beilinson campus, Rabin Medical Center , Petah Tikva 2Thoracic oncology unit, Davidof center , Rabin Medical Center ,Petah Tikva 3Sackler School of Medicine,Tel Aviv University, Tel Aviv , Israel Introduction : Patients with IPF have a poor prognosis, with a high mortality rate. The incidence of lung cancer (LC) is markedly increased among patients with IPF . After lung transplantation and the following anti-rejection treatment there is an increase the incidence of malignancies . Aim: To define the characteristics of IPF patients who developed lung malignancy during follow up and after lung transplantation.
Methods: We reviewed all cases of primary lung malignancies we have encountered in all IPF patients in our center. We gathered demographic data in general and specific parameters regarding IPF including smoking , duration of diagnosis, transplantation type, histology of the tumor , location of tumor , technique of diagnosis , stage and the sequential treatment and survival .
Results : We gathered 48 IPF patients who developed primary lung cancer 31 during follow up and 17 after single lung transplantation . The mean age in both groups was 64.4 years . Males were more predominant in this cohort (79%). The average time from IPF diagnosis to cancer diagnosis was 3.4 years in the naïve group and the time from transplantation to cancer development was 8.6 years. The location of tumors was more predominant in the lung periphery in both the naïve group (74% vs 23% ) and the transplanted group (71% vs 29%) . Squamous cell carcinoma was more frequent than adenocarcinoma (52% vs 29%) . Malignancies discovered in the naïve group had a tendency to be at a lower stage than the malignancies diagnosed after transplantation , 59% of the later were diagnosed already at stage 4. Average survival was 16 months , 20 months in naïve and 7.2 months in transplanted group (p= 0.38).
Conclusion: Primary lung malignancies in IPF tend to be more predominant in males , peripheral and of squamous type. Malignancies in the IPF transplanted patients appear only in the native fibrotic lung at advanced stages at diagnosis and have a grim prognosis.