今泉 和良

BACKGROUND: Patients with thoracic malignancy and interstitial pneumonia (IP) are often excluded from clinical trials, consequently lacking quantitative evidence of poorer prognosis and lower programmed death-ligand 1 (PD-L1) testing rates. METHODS: We evaluated the real-world impact of comorbid IP on biomarker adoption and survival in thoracic malignancy patients receiving first-line systemic therapy at a tertiary teaching hospital between 2016 and 2023. RESULTS: Among 1247 patients, 98 (7.5%) had comorbid IP. Multigene testing rates in IP patients were similar to those in non-IP patients. Only three actionable genomic alterations were found in the IP group, highlighting PD-L1 testing as the key element. PD-L1 testing was underutilized in the IP group (63.3%) compared with the non-IP group (75.1%). Immune checkpoint inhibitor (ICI) therapy was utilized in 12.2% of IP versus 29.3% in non-IP, despite comparable clinical situations. Comorbid IP predicted worse survival (hazard ratio: 1.789; 95% confidence interval: 1.373-2.331; p < 0.001). Although survival significantly improved in non-IP after 2020, no benefit was observed in IP. A multivariable model incorporating an IP × Period interaction confirmed comorbid IP remained a negative prognostic factor, highlighting recent advances have not bridged the survival disparity for this high-risk group. CONCLUSIONS: Despite recent progress, patients with comorbid IP experience limited clinical benefit, characterized by lower rates of PD-L1 testing, restricted use of immune checkpoint inhibitors, and absence of post-2020 survival gains. This large-scale and quantitative evidence demonstrates persistent disparities and their prognostic significance, reflecting the limited applicability of current immunotherapy-based strategies in this high-risk population.

BACKGROUND: We compared the capabilities of quantitatively assessed paired inspiratory-expiratory area-detector computed tomography (ADCT) for pulmonary functional loss and disease severity evaluations between upright and supine ADCT in matched progressive pulmonary fibrosis (PPF) patients. MATERIALS AND METHODS: This retrospective cohort consisted of age-, sex-, and underlying disease-matched patients with PPF who underwent paired inspiratory-expiratory CT on upright ADCT (n = 40) and supine ADCT (n = 40), pulmonary function tests, and disease severity assessment. Based on CT data, the absolute values of the logarithm of the Jacobian determinant and warp-field magnitude of the whole lung and all lobes were calculated. Stepwise regression analyses were performed. RESULTS: On supine ADCT, both indices of the left lower lobe (LLL) were the first and only steps for pulmonary function test results and CT-assessed disease severity (absolute value of the logarithm of the Jacobian determinant: 0.139 ≤ r2 ≤ 0.175, 0.007 ≤ p ≤ 0.018; absolute value of the warp-field magnitude: 0.371 ≤ r2 ≤ 0.447, p < 0.001). However, on upright ADCT, both indices indicated that LLL was the first step and the right lower lobe was the second step for pulmonary function test results and CT-assessed disease severity (0.503 ≤ r2 ≤ 0.674, p < 0.001 or 0.000 < p ≤ 0.006 and 0.474 ≤ r2 ≤ 0.652, 0.002 ≤ p ≤ 0.045, respectively). CONCLUSION: Upright ADCT has equal to or better potential than supine ADCT for detecting pulmonary functional loss and evaluating disease severity when paired inspiratory-expiratory ADCT is applied in PPF patients. RELEVANCE STATEMENT: Upright ADCT has superior potential to supine ADCT for pulmonary functional loss and disease severity evaluations when paired inspiratory-expiratory ADCT is performed in patients with progressive pulmonary fibrosis (PPF). KEY POINTS: Matched progressive pulmonary fibrosis patients compared functional loss and disease severity evaluations between inspiratory-expiratory upright and supine area-detector CT. Clinical parameters demonstrated better correlations with upright than with supine inspiratory-expiratory area-detector CT. Warp-field magnitude showed better correlations with disease severities than the logarithm of the Jacobian determinant on each area-detector CT.