Factors associated with severity of MTX-related neutropenia (n = 37).

<p>Factors associated with severity of MTX-related neutropenia (n = 37).</p

Severity of myelosuppression related to low-dose MTX therapy for inflammatory rheumatic diseases (n = 40).

<p>Severity of myelosuppression related to low-dose MTX therapy for inflammatory rheumatic diseases (n = 40).</p

Factors associated with severity of MTX-related pancytopenia (n = 31).

<p>Factors associated with severity of MTX-related pancytopenia (n = 31).</p

Cumulative incidence of lung cancer-related death in all patients grouped by HRCT-based CPFE diagnosis.

Using the CIF, the cumulative incidence of lung cancer-related death in patients who were newly given a diagnosis of lung cancer is shown in the CPFE group, the ILD or emphysema alone group, and the group without ILD or emphysema. Numbers below these figures represent the number of patients at risk. The cumulative incidence of death over time among groups was compared using Gray’s test with the post hoc Holm’s procedure (p < 0.001 for a comparison among the three groups, CPFE vs. without ILD or emphysema, and ILD or emphysema alone vs. without ILD or emphysema). HRCT, high-resolution computed tomography; CPFE, combined pulmonary fibrosis and emphysema; ILD, interstitial pneumonia; PE, pulmonary emphysema; CIF, cumulative incidence function.</p

Clinical and laboratory characteristics of patients who developed myelosuppression during low-dose MTX.

<p>Clinical and laboratory characteristics of patients who developed myelosuppression during low-dose MTX.</p

HRCT scans of a 65-year-old man with rheumatoid arthritis and CPFE.

HRCT images show the coexistence of emphysema (A) and pulmonary fibrosis (B, the UIP pattern of fibrotic ILD). The images show a typical distribution of the disease in CPFE. The zones of fibrosis and emphysema are completely separated. Paraseptal emphysema is localized to the upper lobes and fibrosis characterized by honeycombing and traction bronchiectasis is localized to the lung bases. Reticular abnormality is also present. HRCT, high-resolution computed tomography; RA, rheumatoid arthritis; CPFE, combined pulmonary fibrosis and emphysema; UIP, usual interstitial pneumonia; ILD, interstitial lung disease. (TIF)</p

Comparison of RA-related factors among lung cancer patients grouped according to HRCT-based CPFE diagnosis.

Comparison of RA-related factors among lung cancer patients grouped according to HRCT-based CPFE diagnosis.</p

Mortality in patients newly diagnosed with lung cancer.

Mortality in patients newly diagnosed with lung cancer.</p

Clinical characteristics at diagnosis of lung cancer.

Clinical characteristics at diagnosis of lung cancer.</p

DMARD therapy at diagnosis of lung cancer.

ObjectiveCombined pulmonary fibrosis and emphysema (CPFE) is a syndrome characterized by the coexistence of emphysema and fibrotic interstitial lung disease (ILD). The aim of this study was to examine the effect of CPFE on lung cancer risk and lung cancer-related mortality in patients with rheumatoid arthritis (RA).MethodsWe conducted a multicenter retrospective cohort study of patients newly diagnosed with lung cancer at five community hospitals between June 2006 and December 2021. Patients were followed until lung cancer-related death, other-cause death, loss to follow-up, or the end of the study. We used the cumulative incidence function with Gray’s test and Fine-Gray regression analysis for survival analysis.ResultsA total of 563 patients with biopsy-proven lung cancer were included (82 RA patients and 481 non-RA patients). The prevalence of CPFE was higher in RA patients than in non-RA patients (40.2% vs.10.0%) at lung cancer diagnosis. During follow-up, the crude incidence rate of lung cancer-related death was 0.29 and 0.10 per patient-year (PY) in RA and non-RA patients, and 0.32 and 0.07 per PY in patients with CPFE and patients without ILD or emphysema, respectively. The estimated death probability at 5 years differed between RA and non-RA patients (66% vs. 32%, ppConclusionsRA patients with lung cancer had a higher prevalence of CPFE and increased cancer-related mortality compared with non-RA patients. Close monitoring and optimal treatment strategies tailored to RA patients with CPFE are important to improve the poor prognosis of lung cancer.</div