Abstract
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: The results of our in vivo model illustrated that the microenvironment of BLM-induced interstitial pneumonia facilitated the development of postoperative lung metastasis. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00432-026-06445-5.