Supplementary Table 1. Univariate and multivariate analysis of overall survival in patients with lung cancer.
Univariate analysis Multivariate analysis
Variables n
Sex
Age
Clinical stage
Smoking (pack-year)
Histology
CPFE
Female 872 (ref)
Male 1461
<70 1318 (ref)
>70 1015
Stage I 1779 (ref)
Others 554
<40 1547 (ref)
>40 786
SCC 460 (ref)
Others 1873
- 2176 (ref)
Adjusted HR
HR (95% CI)
2.4 (2.0-3.0)
P
< 0.001
(95% CI)
1.9 (1.5-2.3)
P
< 0.001
1.7 (1.5-2.1) < 0.001 1.8 (1.5-2.2) < 0.001
3.1 (2.6-3.7) < 0.001 2.9 (2.4-3.5) < 0.001
1.7 (1.5-2.1) < 0.001 1.0 (0.8-1.2) 0.99
1.7 (1.4-2.1) < 0.001 0.9 (0.8-1.1)
+ 157
CFPE, combined pulmonary fibrosis and emphysema; CI, confidence interval; HR, hazard ratio; SCC, squamous cell carcinoma.
0.49
3.5 (2.8-4.6) < 0.001 2.7 (2.1-3.6) < 0.001
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Supplementary Table 2. Preoperative clinicopathological findings of patients with lung cancer and with combined pulmonary fibrosis and emphysema.
Variables With CPFE (n = 233)
Sex
Female
Male
Age
Median (IQR)
Clinical stage
I
II
III
Performance status
0 PS
1 PS
2 PS
Smoking (pack-years)
< 40
≥ 40
%VC
Median (IQR)
FEV1.0% (%)
21 (9)
212 (91)
72 (66-72)
166 (71)
42 (18)
25 (11)
180 (77)
50 (21)
3 (1)
74 (32)
159 (68)
98.4 (89.3-109.2)
Median (IQR) 71.5 (65.4-77.5)
Missing data were excluded from analysis. Data are presented as counts and ratios (%) or as medians and interquartile ranges as appropriate. * With combined pulmonary fibrosis and emphysema. CPFE, combined pulmonary fibrosis and emphysema; FEV1.0%, forced expiratory volume in 1 second %; IQR, interquartile range; %VC, ratio of forced vital capacity.
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Supplementary Table 3.
Operative and postoperative findings of patients with lung cancer and with combined pulmonary fibrosis and emphysema.
Variable With CPFE (n = 233)
Pathological stage
I
II
III
Histology
Adenocarcinoma
Squamous cell carcinoma
Large cell carcinoma
Pleomorphic carcinoma
Others
Procedure
Pneumonectomy
Lobectomy
Segmentectomy
Wedge resection
Postoperative complications related to respiratory
+
-
Home oxygen therapy
+
-
Unknown
118 (51)
60 (26)
55 (24)
14 (6)
186 (80)
84 (36)
111 (48)
15 (6)
9 (4)
5 (2)
198 (85)
8 (3)
22 (9)
47 (20)
31 (13)
151 (65)
51 (22)
Hospital stay after surgical resection
Median (IQR)
30-day mortality
+
-
90-day mortality
+
11 (8-15.5)
6 (3)
227 (97)
15 (6)
- 218 (94)
Missing data were excluded from analysis. Data are presented as counts and ratios
(%) or as medians and ranges, as appropriate. CPFE, combined pulmonary fibrosis and emphysema. IQR, interquartile range.
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Supplementary Table 4. Morbidity after surgical resection in patients with lung cancer patients and combined pulmonary fibrosis and emphysema.
Variables Grade 4 (n = 4) Grade 5 (n = 10)
Postoperative complications
Prolonged air leakage (> 7 days)
Pneumonia
Bronchopleural fistula
Empyema
4
0
0
2
0
1 Acute respiratory distress syndrome
Acute exacerbation of idiopathic pulmonary fibrosis 1
Missing data were excluded from analysis.
10
0
0
3
1
2
4
4

Figure legends
Supplementary Figure 1.
Representative CT image of combined pulmonary fibrosis and emphysema.
(A) Emphysema with multiple bullae (> 1 cm) in upper lobe. (B) Diffuse parenchymal lung disease with significant pulmonary fibrosis.
Supplementary Figure 2. Kaplan-Meier curves of cumulative incidence of death due to cancer of all patients with lung cancer and with combined pulmonary fibrosis and emphysema, and according to clinical stage I or II/III cancer and %VC (< 100% and ≥
100%).
Three-year cumulative incidence of cancer deaths for all patients (A), those with CPFE and clinical stage I and II/III disease (B) and those with %VC < 100% or ≥ 100% (C):
(A) 20.1% (14.7% - 27.2%), (B) 16.0% (10.4% - 24.3%) vs. 30.9% (19.8% - 46.2%); P
= 0.010) and (C) 22.3% (14.7% - 33.1%) vs. 17.9% (11.1% - 28.3%); P = 0.30), respectively.
Supplementary Figure 3. Kaplan-Meier curves of cumulative incidence of death due to other causes of all patients with lung cancer and with combined pulmonary fibrosis and emphysema, and according to clinical stage I or II/III cancer and %VC (< 100% and ≥
100%).
Three-year cumulative incidence of non-cancer death for all patients (A): 27.6% (21.5%
- 35.1%). Three-year cumulative incidence of non-cancer death for patients with combined pulmonary fibrosis and emphysema and clinical stage I or II/III cancer (B) and for those with %VC < 100% or ≥ 100% (C): (B) 26.3% (19.3% - 35.3%) vs. 31.2%
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(20.2% - 46.2%); P = 0.21, (C) 37.3% (28.0% - 48.5%) vs. 16.6% (10.2% - 26.3%); P =
0.0048, respectively.
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