Abstract
BACKGROUND: Combined pulmonary fibrosis and emphysema (CPFE) represents a distinct clinical syndrome characterized by the coexistence of upper lobe emphysema and lower lobe fibrosis, with an increased risk of lung cancer (LC) development. This study aimed to detect the clinical features and prognosis of CPFE patients with LC and the ability of neutrophil-to-lymphocyte ratio (NLR) to predict outcomes in those individuals. METHODS: A retrospective cohort study involving patients diagnosed with CPFE combined with LC between January 2017 and December 2023 was conducted. Clinical characteristics, laboratory parameters and survival data were collected. RESULTS: A total of 80 CPFE patients with LC were included, with a mean age of 68.1 years, and a male predominance (93.8%). The LCs were predominantly adenocarcinomas (38.8%), with a significant proportion diagnosed at advanced stages (22.5% at stage III, 47.5% at stage IV) and preferential peripheral pulmonary localization (72.5%). CPFE patients with LC had estimated 1-year, 3-year, and 5-year survival rates of 52%, 40%, and 37%, respectively, with a median overall survival of 29.2 months. Multivariate Cox regression analysis revealed that increased NLR [adjusted hazard ratio (HR) 1.180, 95% confidence interval CI 1.029-1.352, p = 0.018] and elevated carcinoembryonic antigen (CEA) (adjusted HR 1.005, 95% CI 1.000-1.010, p = 0.036) were related to an enhanced risk of all-cause mortality. Receiver-operating characteristic analysis identified an NLR cutoff value of 2.6 as a predictor of all-cause death within 24 months [area under the curve = 0.651; specificity = 62.1%; sensitivity = 66.6%; p < 0.05]. Patients with an NLR greater than 2.6 had a significantly greater risk of all-cause death than those with an NLR of 2.6 or less (adjusted HR 2.3, 95% CI 1.197-4.754; p = 0.011). CONCLUSIONS: The NLR may serve as a cost-effective and widely accessible biomarker for risk stratification, particularly in CPFE patients with advanced-stage LC. In our cohort, an NLR cutoff value of 2.6 provides improved prognostic accuracy in predicting mortality outcomes.