Idiopathic pulmonary fibrosis predicts local recurrence following surgery in patients with non-small cell lung cancer

Purpose The prognosis of lung cancer patients with idiopathic pulmonary fibrosis (IPF) is reported to be worse than that of those without IPF. Herein, we investigated the prognosis of non-small cell lung cancer (NSCLC) patients with and without IPF who underwent resection, and established a new postoperative therapeutic strategy for NSCLC patients with IPF. Methods Between 2011 and 2020, 437 consecutive patients with pathological stage I NSCLC who underwent complete resection with systematic lymph node dissection were retrospectively analyzed. Results Of 437 patients, post-propensity score matching analysis showed the five-year recurrence-free probability was significantly lower for patients with IPF than for those without IPF (32.3% and 76.1%, respectively; p  < 0.001). Compared to those without IPF, postoperative lung metastasis was more frequently encountered in patients with IPF. We then hypothesized that the lung microenvironment of IPF facilitates pulmonary tumor recurrence. In an in vivo mouse model of bleomycin (BLM)-induced IPF, the lung microenvironment of IPF promoted lung metastasis of lung cancer cells which was inhibited by the pharmacological treatment of IPF with pirfenidone (PFD). Conclusion Our findings may pave the way for further clinical studies on the postoperative use of pirfenidone—either alone or alongside conventional adjuvant chemotherapy—to prevent postoperative lung metastasis in NSCLC patients with IPF.