Toshihiko Sato1, Satoshi Teramukai2, Haruhiko Kondo3, Atsushi Watanabe4, Masahito Ebina5, Kazuma Kishi6, Yoshitaka Fujii7, Tetsuya Mitsudomi8, Masahiro Yoshimura9, Tomohiro Maniwa10, Kenji Suzuki11, Kazuhiko Kataoka12, Yukihiko Sugiyama13, Takashi Kondo14, Hiroshi Date15. 1. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. 2. Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan. 3. Department of Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan. 4. Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan. 5. Department of Respirology, Tohoku University, Sendai, Japan. 6. Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan. 7. Department of Oncology, Immunology and Surgery, Nagoya City University, Nagoya, Japan. 8. Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan (presently at the Department of Thoracic Surgery, Kinki University Faculty of Medicine, Osaka, Japan). 9. Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan. 10. Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 11. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 12. Department of Thoracic Surgery, Hiroshima City Hospital, Hiroshima, Japan (presently at the Department of Thoracic Surgery, Iwakuni Clinical Center, Yamaguchi, Japan). 13. Department of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan. 14. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan. 15. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. Electronic address: hdate@kuhp.kyoto-u.ac.jp.
Abstract
OBJECTIVE: The study objective was to examine the incidence, risk factors, and mortality rate of acute exacerbation of interstitial lung diseases in patients with lung cancer undergoing pulmonary resection in a large-scale multi-institutional cohort. METHODS: We retrospectively analyzed 1763 patients with non-small cell lung cancer who had undergone pulmonary resection and presented with a clinical diagnosis of interstitial lung diseases between January 2000 and December 2009 at 61 hospitals in Japan. The incidence and outcomes of acute exacerbation within 30 days from the operation were investigated. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of acute exacerbation. RESULTS: Acute exacerbation occurred in 164 patients (9.3%; 95% confidence interval, 8.0-10.8), with a mortality rate of 43.9%, and was the top cause of 30-day mortality (71.7%). The following 7 independent risk factors of acute exacerbation were identified: surgical procedures, male sex, history of exacerbation, preoperative steroid use, serum sialylated carbohydrate antigen KL-6 levels, usual interstitial pneumonia appearance on computed tomography scan, and reduced percent predicted vital capacity. Surgical procedures showed the strongest association with acute exacerbation (using wedge resection as the reference, lobectomy or segmentectomy: odds ratio, 3.83; 95% confidence interval, 1.94-7.57; bi-lobectomy or pneumonectomy: odds ratio, 5.70; 95% confidence interval, 2.38-13.7; P < .001). The effect of perioperative prophylactics, such as steroids and sivelestat, was not confirmed in this study. CONCLUSIONS: Pulmonary resection for patients with lung cancer with interstitial lung diseases may provoke acute exacerbation at a substantially high rate and has high associated mortality. Surgical procedures that proved to be a risk factor for acute exacerbation should be chosen cautiously for these high-risk patients.
OBJECTIVE: The study objective was to examine the incidence, risk factors, and mortality rate of acute exacerbation of interstitial lung diseases in patients with lung cancer undergoing pulmonary resection in a large-scale multi-institutional cohort. METHODS: We retrospectively analyzed 1763 patients with non-small cell lung cancer who had undergone pulmonary resection and presented with a clinical diagnosis of interstitial lung diseases between January 2000 and December 2009 at 61 hospitals in Japan. The incidence and outcomes of acute exacerbation within 30 days from the operation were investigated. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of acute exacerbation. RESULTS: Acute exacerbation occurred in 164 patients (9.3%; 95% confidence interval, 8.0-10.8), with a mortality rate of 43.9%, and was the top cause of 30-day mortality (71.7%). The following 7 independent risk factors of acute exacerbation were identified: surgical procedures, male sex, history of exacerbation, preoperative steroid use, serum sialylated carbohydrate antigen KL-6 levels, usual interstitial pneumonia appearance on computed tomography scan, and reduced percent predicted vital capacity. Surgical procedures showed the strongest association with acute exacerbation (using wedge resection as the reference, lobectomy or segmentectomy: odds ratio, 3.83; 95% confidence interval, 1.94-7.57; bi-lobectomy or pneumonectomy: odds ratio, 5.70; 95% confidence interval, 2.38-13.7; P < .001). The effect of perioperative prophylactics, such as steroids and sivelestat, was not confirmed in this study. CONCLUSIONS: Pulmonary resection for patients with lung cancer with interstitial lung diseases may provoke acute exacerbation at a substantially high rate and has high associated mortality. Surgical procedures that proved to be a risk factor for acute exacerbation should be chosen cautiously for these high-risk patients.
Authors: Mizuki Nishino; Stephanie Cardarella; Suzanne E Dahlberg; Tetsuro Araki; Christine Lydon; David M Jackman; Michael S Rabin; Hiroto Hatabu; Bruce E Johnson Journal: Eur J Radiol Date: 2015-02-07 Impact factor: 3.528