Toshihiko Sato1, Atsushi Watanabe2, Haruhiko Kondo3, Masato Kanzaki4, Kenichi Okubo5, Kohei Yokoi6, Kazuya Matsumoto7, Takashi Marutsuka8, Hirohiko Shinohara9, Satoshi Teramukai10, Kazuma Kishi11, Masahito Ebina12, Yukihiko Sugiyama13, Okumora Meinoshin14, Hiroshi Date15. 1. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. 2. Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan. 3. Department of Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan. 4. Department of Surgery I, Tokyo Women's Medical University Hospital, Tokyo, Japan. 5. Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan. 6. Department of Thoracic Surgery, Nagoya University Hospital, Nagoya, Japan. 7. Kishiwada City Hospital, Kishiwada, Japan. 8. Kumamoto Chuo Hospital, Kumamoto, Japan. 9. Niigata University Graduate School of Medical and Dental Sciences of Thoracic and Cardiovascular Surgery, Niigata, Japan. 10. Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan. 11. Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan. 12. Respiratory Center, Tohoku Pharmaceutical University Hospital, Sendai, Japan. 13. Department of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan. 14. Department of General Thoracic Surgery, Oosaka Medical Center for Cancer and Cardiovascular Diseases, Oosaka, Japan. 15. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. Electronic address: hdate@kuhp.kyoto-u.ac.jp.
Abstract
OBJECTIVES: Patients with interstitial lung diseases have a poor prognosis and are at increased risk of developing lung cancer. We evaluated the survival and predictors of survival after surgical resection in lung cancers in patients with interstitial lung diseases. METHODS: We retrospectively analyzed data from 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease who underwent pulmonary resection between 2000 and 2009 at 61 Japanese institutions. RESULTS: Male patients (90.4%) and smokers (93.8%) were in the majority. The overall 5-year survival was 40%. The 5-year survivals were 59%, 42%, 43%, 29%, 25%, 17%, and 16% for patients with stage Ia, Ib, IIa, IIb, IIIa, IIIb, and IV, respectively. Patients with stage IA had a 5-year survival of 33.2%, 61.0%, and 68.4% in the wedge resection, segmentectomy, and lobectomy groups, respectively (log-rank test, P = .0038). The leading cause of death was cancer recurrence (50.2%), followed by respiratory failure (26.8%). Wedge resection reduced mortality due to respiratory failure when compared with that of lobectomy (P = .022). Multivariable analysis revealed that the type of surgical procedure, predicted percent vital capacity, and tumor locations were independent predictors for survival. The 5-year survival was 20% for patients with stage Ia with a predicted percent vital capacity of 80% or less, and 64.3% for patients with a predicted percent vital capacity greater than 80% (log-rank test, P < .0001). CONCLUSIONS: In these patients, there are competing risks of death. Wedge resection reduced death caused by respiratory failure but resulted in poorer long-term prognosis than lobectomy. For patients with poor predictors of survival, such as predicted percent vital capacity of 80% or less, surgical resection should be limited.
OBJECTIVES:Patients with interstitial lung diseases have a poor prognosis and are at increased risk of developing lung cancer. We evaluated the survival and predictors of survival after surgical resection in lung cancers in patients with interstitial lung diseases. METHODS: We retrospectively analyzed data from 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease who underwent pulmonary resection between 2000 and 2009 at 61 Japanese institutions. RESULTS: Male patients (90.4%) and smokers (93.8%) were in the majority. The overall 5-year survival was 40%. The 5-year survivals were 59%, 42%, 43%, 29%, 25%, 17%, and 16% for patients with stage Ia, Ib, IIa, IIb, IIIa, IIIb, and IV, respectively. Patients with stage IA had a 5-year survival of 33.2%, 61.0%, and 68.4% in the wedge resection, segmentectomy, and lobectomy groups, respectively (log-rank test, P = .0038). The leading cause of death was cancer recurrence (50.2%), followed by respiratory failure (26.8%). Wedge resection reduced mortality due to respiratory failure when compared with that of lobectomy (P = .022). Multivariable analysis revealed that the type of surgical procedure, predicted percent vital capacity, and tumor locations were independent predictors for survival. The 5-year survival was 20% for patients with stage Ia with a predicted percent vital capacity of 80% or less, and 64.3% for patients with a predicted percent vital capacity greater than 80% (log-rank test, P < .0001). CONCLUSIONS: In these patients, there are competing risks of death. Wedge resection reduced death caused by respiratory failure but resulted in poorer long-term prognosis than lobectomy. For patients with poor predictors of survival, such as predicted percent vital capacity of 80% or less, surgical resection should be limited.
Authors: Mizuki Nishino; Suzanne E Dahlberg; Linnea E Fulton; Subba R Digumarthy; Hiroto Hatabu; Bruce E Johnson; Lecia V Sequist Journal: Acad Radiol Date: 2016-01-08 Impact factor: 3.173