Takahiro Omori1, Michihiko Tajiri2, Tomohisa Baba3, Takashi Ogura3, Tae Iwasawa4, Koji Okudela5, Tamiko Takemura6, Mari S Oba7, Takamitsu Maehara8, Haruhiko Nakayama9, Masahiro Tsuboi10, Munetaka Masuda11. 1. Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan. Electronic address: taka-ohmori@cocoa.plala.or.jp. 2. Department of Thoracic Surgery, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan. 3. Department of Respiratory Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan. 4. Department of Radiology, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan. 5. Department of Pathology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. 6. Department of Pathology, Japanese Red Cross Medical Center, Tokyo, Japan. 7. Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan. 8. Department of Thoracic Surgery, Yokohama Rosai Hospital, Yokohama, Japan. 9. Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan. 10. Division of Thoracic Surgery and Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan. 11. Department of Surgery, Graduate School of Medicine, Yokohama City University, Yokohama, Japan.
Abstract
BACKGROUND: After pulmonary resection, patients with lung cancer who have idiopathic pulmonary fibrosis (IPF) have been reported to have higher pulmonary morbidity and mortality and poorer outcomes than patients without IPF. However, whether morbidity, mortality, and outcomes differ according to the subtype of idiopathic interstitial pneumonia (IIP) remains unclear. METHODS: The clinical records of 678 patients with non-small cell lung cancer who underwent pulmonary resection were reviewed retrospectively. A total of 103 patients had IIP and were classified into an IPF group and a non-IPF group in accordance with the 2011 statement. RESULTS: The IPF group comprised 46 patients, and the non-IPF group comprised 57. The 5-year survival rate was significantly higher in the non-IPF group (53.2%) than in the IPF group (22.1%; p = 0.0093). Cause of death was IIP-related respiratory failure in 26.1% (12 of 46) of the patients in the IPF group as compared with 7.0% (4 of 57) of patients in the non-IPF group (p = 0.008). Multivariate Cox analysis indicated that IPF was a significant predictor of long-term survival (hazard ratio 1.910, 95% confidence interval: 1.102 to 3.313; p = 0.021). CONCLUSIONS: Idiopathic pulmonary fibrosis is independently associated with poorer overall survival in patients with lung cancer who undergo pulmonary resection. The decision whether to perform surgery in patients who have lung cancer with IIP should therefore take into account the subtype of IIP and the poorer outcomes associated with IPF.
BACKGROUND: After pulmonary resection, patients with lung cancer who have idiopathic pulmonary fibrosis (IPF) have been reported to have higher pulmonary morbidity and mortality and poorer outcomes than patients without IPF. However, whether morbidity, mortality, and outcomes differ according to the subtype of idiopathic interstitial pneumonia (IIP) remains unclear. METHODS: The clinical records of 678 patients with non-small cell lung cancer who underwent pulmonary resection were reviewed retrospectively. A total of 103 patients had IIP and were classified into an IPF group and a non-IPF group in accordance with the 2011 statement. RESULTS: The IPF group comprised 46 patients, and the non-IPF group comprised 57. The 5-year survival rate was significantly higher in the non-IPF group (53.2%) than in the IPF group (22.1%; p = 0.0093). Cause of death was IIP-related respiratory failure in 26.1% (12 of 46) of the patients in the IPF group as compared with 7.0% (4 of 57) of patients in the non-IPF group (p = 0.008). Multivariate Cox analysis indicated that IPF was a significant predictor of long-term survival (hazard ratio 1.910, 95% confidence interval: 1.102 to 3.313; p = 0.021). CONCLUSIONS:Idiopathic pulmonary fibrosis is independently associated with poorer overall survival in patients with lung cancer who undergo pulmonary resection. The decision whether to perform surgery in patients who have lung cancer with IIP should therefore take into account the subtype of IIP and the poorer outcomes associated with IPF.
Authors: Stacey-Ann Whittaker Brown; Maria Padilla; Grace Mhango; Emanuela Taioli; Charles Powell; Juan Wisnivesky Journal: Ann Am Thorac Soc Date: 2019-08