Abstract

Pulmonary idiopathic fibrosis (IPF) is characterized by a proliferative landscape, which recalls that of cancer. Moreover, IPF diagnosis is associated to a significantly higher risk of lung cancer (LC) development. We  evaluated a cohort of 28 IPF patients followed in our Institution who subsequently developed lung cancer, 21 were males and the remaining 7 females. The median age at IPF diagnosis was 66.3 years, and the median interval to subsequent LC onset was 2.75 years. Most patients (22) were past or current smokers, 14 referred heart diseases, 11 other lung diseases (COPD, OSAS), 5 gastroesophageal reflux disease and 6 diabetes. Adenocarcinoma was diagnosed in 18 cases, 5 were squamous cell carcinomas and 4 small cell LC; the remaining were undifferentiated cancers; 15 out of the 28 cases carried early-stage disease defined as peripheral nodule in parenchyma spared from dense fibrosis. In most cases (21) PD-L1 was poorly expressed. Therapeutic approaches were decided based on disease stage, patient performance status and after multidisciplinary evaluation. The median overall survival was 16.3 months. The entire dataset was then processed according to partitioning method and clustering analysis by using JMP software too. Overall, the most relevant parameters associated to patient outcomes (death) are IPF treatments,smoking habit and age at IPF diagnosis in females and IPF treatments, comorbidities and tumor stages in males. Quite unespectedly, according to the decision tree, concomitant comorbities best predict resposne (patient time to death) irrespective of cancer histotype and stage and IPF severity.