Takahiro Mimae1, Kenji Suzuki2, Masahiro Tsuboi3,4, Kanji Nagai3, Norihiko Ikeda5, Tetsuya Mitsudomi6, Hisashi Saji7, Sakae Okumura8, Meinoshin Okumura9, Kenichi Yoshimura10,11, Morihito Okada12. 1. Department of Surgical Oncology, Hiroshima University, Minami-ku, Hiroshima, Japan. 2. Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan. 3. Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa, Japan. 4. Respiratory Disease Center, Yokohama City University Medical Center, Yokohama, Japan. 5. Department of Surgery I, Tokyo Medical University Hospital, Tokyo, Japan. 6. Division of Thoracic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan. 7. Department of Chest Surgery, St. Marianna University School of Medicine, Kawasaki, Japan. 8. Department of Thoracic Surgery, Cancer Institute Hospital, Tokyo, Japan. 9. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan. 10. Innovative Clinical Research Center (iCREK), Kanazawa University Hospital, Kanazawa, Japan. 11. Department of Applied Biostatistics, Kobe University Graduate School of Medicine, Kobe, Japan. 12. Department of Surgical Oncology, Hiroshima University, Minami-ku, Hiroshima, Japan. morihito1217@hiroshima-u.ac.jp.
Abstract
PURPOSE: Lung cancers in patients with combined pulmonary fibrosis and emphysema (CPFE) are increasing. Objective of this investigation was to identify which clinicopathological features significantly affected surgical outcome of these patients. METHODS: Among 4313 patients with primary lung cancers who underwent surgery between January 2008 and December 2010 in nine institutions in Japan, 265 had CPFE. We retrospectively compared 2176 and 157 patients without and with CPFE, respectively, and further analyzed 233 patients with CPFE whose detailed information was available. CPFE was defined as upper lobe emphysema and lower lobe fibrosis. RESULTS: The rates of postoperative morbidity and mortality were higher and overall survival was poorer in patients with, than without CPFE. Among 233 patients with CPFE, the median values of %VC and FEV1.0 % were 98.4 and 71.5 %, respectively. The histological types comprised 111 squamous cell carcinomas and 84 adenocarcinomas. Surgical procedures included 203 standard lobectomies/pneumonectomies and 30 lesser resections. Five patients (2 %) developed postoperative acute exacerbation of interstitial pneumonia. Six and 15 patients (3 and 6 %) died within 30- and 90-postoperative-day, respectively. Cancer was the cause of death at 90-day in only one patient. The 3-year overall survival rate for all patients was 58.4 %. Multivariate analysis showed that male sex, advanced age, advanced clinical stage and lower %VC predict a poor prognosis. CONCLUSIONS: Patients with lung cancer and CPFE had poor prognoses regardless of apparently good pulmonary function and showed quite high postoperative mortality rates. A lower %VC that might reflect the severity of pulmonary fibrosis was associated with poor prognoses.
PURPOSE: Lung cancers in patients with combined pulmonary fibrosis and emphysema (CPFE) are increasing. Objective of this investigation was to identify which clinicopathological features significantly affected surgical outcome of these patients. METHODS: Among 4313 patients with primary lung cancers who underwent surgery between January 2008 and December 2010 in nine institutions in Japan, 265 had CPFE. We retrospectively compared 2176 and 157 patients without and with CPFE, respectively, and further analyzed 233 patients with CPFE whose detailed information was available. CPFE was defined as upper lobe emphysema and lower lobe fibrosis. RESULTS: The rates of postoperative morbidity and mortality were higher and overall survival was poorer in patients with, than without CPFE. Among 233 patients with CPFE, the median values of %VC and FEV1.0 % were 98.4 and 71.5 %, respectively. The histological types comprised 111 squamous cell carcinomas and 84 adenocarcinomas. Surgical procedures included 203 standard lobectomies/pneumonectomies and 30 lesser resections. Five patients (2 %) developed postoperative acute exacerbation of interstitial pneumonia. Six and 15 patients (3 and 6 %) died within 30- and 90-postoperative-day, respectively. Cancer was the cause of death at 90-day in only one patient. The 3-year overall survival rate for all patients was 58.4 %. Multivariate analysis showed that male sex, advanced age, advanced clinical stage and lower %VC predict a poor prognosis. CONCLUSIONS:Patients with lung cancer and CPFE had poor prognoses regardless of apparently good pulmonary function and showed quite high postoperative mortality rates. A lower %VC that might reflect the severity of pulmonary fibrosis was associated with poor prognoses.