Background: Lung cancer associated with interstitial lung disease (LC-ILD) represents a highly vulnerable population with limited therapeutic options and increased risk of treatmentrelated complications.Data from Western cohorts remain scarce, especially regarding molecular characteristics and prognostic determinants.Methods: We conducted a retrospective single-center cohort study of all consecutive LC-ILD patients discussed in a thoracic oncology multidisciplinary team (MDT) at Marseille University Hospital between June 2010 and July 2025.Results: A total of 102 patients were included.Mean age was 68.8 years and 83% were men.UIP was the most frequent ILD pattern (61%).Molecular profiling (available for 57%) showed a landscape dominated by TP53 (38%), KRAS (24% including 9% G12C) and PI3KCA (16%), with no EGFR alterations detected.ARE occurred in 42% of patients and were fatal in 67%.Median OS was 17.7 months.In multivariable analysis, higher KCO (HR 0.97 per 1% increase), good performance status, and curative-intent strategy were independently associated with improved survival.Conclusion: KCO and performance status are the strongest independent predictors of survival in LC-ILD.AREs are frequent and highly lethal.Dedicated therapeutic guidelines and an adapted ILD-GAP-cancer prognostic tool are urgently needed.Beyond clinical parameters our findings suggest a distinct molecular landscape dominated by TP53, KRAS and PI3K pathway alteration.
Goga et al. (Sun,) studied this question.