Perioperative pirfenidone treatment for lung cancer patients with idiopathic pulmonary fibrosis



To assess the efficacy and feasibility of perioperative pirfenidone treatment (PPT) in lung cancer patients with idiopathic pulmonary fibrosis (IPF).


The subjects of this retrospective review were 100 patients diagnosed with IPF, who underwent surgical resection for primary lung cancer between January 2011 and April 2018 at our institution. We compared the clinical outcomes of patients treated with pirfenidone (PPT group; n = 28) and those of patients not treated with pirfenidone (non-PPT group; n = 72).


The Japanese Association for Chest Surgery (JACS) risk score was significantly higher in the PPT group (p = 0.020, 10.9 vs. 9.4); therefore, we subdivided the groups based on JACS risk score. In the low-risk group, the incidence of postoperative acute exacerbation (AE) both within the postoperative day (POD) 30 and 90 was 0.0% (0/6) and 6.5% (2/31) in the PPT and non-PPT groups, respectively (p = 0.522). In the intermediate/high-risk group, the incidence of postoperative AE was 4.5% (1/22) and 19.5% (8/41) within POD 30 (p = 0.106) and 4.5% (1/22) and 24.4% (10/41) within POD 90 (p = 0.048) in the PPT and non-PPT groups, respectively. No serious pirfenidone-related complications were observed.


Based on our findings, PPT is an effective and feasible prophylactic treatment to reduce postoperative AE.

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  1. 1.

    Kumar P, Goldstraw P, Yamada K, Nicholson AG, Wells AU, Hansell DM, et al. Pulmonary fibrosis and lung cancer: risk and benefit analysis of pulmonary resection. J Thorac Cardiovasc Surg. 2003;125:1321–7.

    CAS  Article  Google Scholar 

  2. 2.

    Watanabe A, Miyajima M, Mishina T, Nakazawa J, Harada R, Kawaharada N, et al. Surgical treatment for primary lung cancer combined with idiopathic pulmonary fibrosis. Gen Thorac Cardiovasc Surg. 2013;61:254–61.

    Article  Google Scholar 

  3. 3.

    Wada H, Nakamura T, Nakamoto K, Maeda M, Watanabe Y. Thirty-day operative mortality for thoracotomy in lung cancer. J Thoracic Cardiovasc Surg. 1998;115:70–3.

    CAS  Article  Google Scholar 

  4. 4.

    Masuda M, Kuwano H, Okumura M, Amano J, Arai H, Endo S, et al. Thoracic and cardiovascular surgery in Japan during 2012: annual report by the Japanese Association for Thoracic Surgery. Gen Thorac Cardiovasc Surg. 2014;62:734–64.

    Article  Google Scholar 

  5. 5.

    Chiyo M, Sekine Y, Iwata T, Tatsumi K, Yasufuku K, Iyoda A, et al. Impact of interstitial lung disease on surgical morbidity and mortality for lung cancer: analyses of short-term and long-term outcomes. J Thorac Cardiovasc Surg. 2003;126:1141–6.

    Article  Google Scholar 

  6. 6.

    Koizumi K, Hirata T, Hirai K, Mikami I, Okada D, Yamagishi S, et al. Surgical treatment of lung cancer combined with interstitial pneumonia: the effect of surgical approach on postoperative acute exacerbation. Ann Thorac Cardiovasc Surg. 2004;10:340–6.

    PubMed  Google Scholar 

  7. 7.

    Watanabe A, Kawaharada N, Higami T. Postoperative acute exacerbation of IPF after lung resection for primary lung cancer. Pulm Med. 2011;2011:960316.

    Article  Google Scholar 

  8. 8.

    Sato T, Teramukai S, Kondo H, Watanabe A, Ebina M, Kishi K, et al. Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer. J Thorac Cardiovasc Surg. 2014;147:1604–11.

    Article  Google Scholar 

  9. 9.

    Sato T, Kondo H, Watanabe A, Nakajima J, Niwa H, Horio H, et al. A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients. Gen Thorac Cardiovasc Surg. 2015;63:164–72.

    Article  Google Scholar 

  10. 10.

    Ginsberg RJ, Rubinstein LV. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thoracic Surg. 1995;60:615–23.

    CAS  Article  Google Scholar 

  11. 11.

    Saito Y, Kawai Y, Takahashi N, Ikeya T, Murai K, Kawabata Y, et al. Survival after surgery for pathologic stage IA non-small cell cancer associated with idiopathic pulmonary fibrosis. Ann Thorac Surg. 2011;92:1812–7.

    Article  Google Scholar 

  12. 12.

    Iwata T, Yoshida S, Nagato K, Nakajima T, Suzuki H, Tagawa T, et al. Experience with perioperative pirfenidone for lung cancer surgery in patients with idiopathic pulmonary fibrosis. Surg Today. 2015;45:1263–70.

    Article  Google Scholar 

  13. 13.

    Iwata T, Yoshino I, Yoshida S, Ikeda N, Tsuboi M, Asato Y, et al. A phase II trial evaluating the efficacy and safety of perioperative pirfenidone for prevention of acute exacerbation of idiopathic pulmonary fibrosis in lung cancer patients undergoing pulmonary resection: West Japan Oncology Group 6711 L (PEOPLE Study). Respir Res. 2016;17:90.

    Article  Google Scholar 

  14. 14.

    Iwata T, Yoshida S, Fujiwara T, Wada H, Nakajima T, Suzuki H, et al. Effect of perioperative pirfenidone treatment in lung cancer patients with idiopathic pulmonary fibrosis. Ann Thorac Surg. 2016;102:1905–10.

    Article  Google Scholar 

  15. 15.

    Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, et al. An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med. 2011;183:788–824.

    Article  Google Scholar 

  16. 16.

    Yoshimura K, Nakatani T, Nakamori Y, Chonabayashi N, Tachibana A, Nakata K, et al. Acute exacerbation in idiopathic interstitial pneumonia. Nihon Kyobu Shikkan Gakkai Zasshi. 1984;22:1012–20.

    CAS  PubMed  Google Scholar 

  17. 17.

    Azuma A, Taguchi Y, Ogura T, Ebina M, Taniguchi H, Kondoh Y, et al. Exploratory analysis of a phase III trial of pirfenidone identifies a subpopulation of patients with idiopathic pulmonary fibrosis as benefiting from treatment. Respir Res. 2011;12:143.

    CAS  Article  Google Scholar 

  18. 18.

    Minegishi Y, Takenaka K, Mizutani H, Sudoh J, Noro R, Okano T, et al. Exacerbation of idiopathic interstitial pneumonias associated with lung cancer therapy. Intern Med. 2009;48:665–72.

    Article  Google Scholar 

  19. 19.

    Isobe K, Hata Y, Sakamoto S, Takai Y, Shibuya K, Homma S. Clinical characteristics of acute respiratory deterioration in pulmonary fibrosis associated with lung cancer following anti-cancer therapy. Respirology. 2010;15:88–92.

    Article  Google Scholar 

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Correspondence to Masatoshi Kanayama.

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Kanayama, M., Mori, M., Matsumiya, H. et al. Perioperative pirfenidone treatment for lung cancer patients with idiopathic pulmonary fibrosis. Surg Today 50, 469–474 (2020).

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  • Perioperative pirfenidone
  • Lung cancer
  • Idiopathic pulmonary fibrosis