General Thoracic and Cardiovascular Surgery

, Volume 63, Issue 3, pp 164–172 | Cite as

A simple risk scoring system for predicting acute exacerbation of interstitial pneumonia after pulmonary resection in lung cancer patients

  • Toshihiko Sato
  • Haruhiko Kondo
  • Atsushi Watanabe
  • Jun Nakajima
  • Hiroshi Niwa
  • Hirotoshi Horio
  • Jiro Okami
  • Norihito Okumura
  • Kenji Sugio
  • Satoshi Teramukai
  • Kazuma Kishi
  • Masahito Ebina
  • Yukihiko Sugiyama
  • Takashi Kondo
  • Hiroshi DateEmail author
Original Article



Lung cancer patients with interstitial lung diseases (ILDs) who have undergone pulmonary resection often develop acute exacerbation of interstitial pneumonia (AE) in the post-operative period. To predict who is at high risk of AE, we propose a scoring system that evaluates the risk of AE in lung cancer patients with ILDs.


We derived a score for 30-day risk of AE onset after pulmonary resection in lung cancer patients with ILDs (n = 1,022; outcome: risk of AE) based on seven risk factors for AE that were identified in a previous retrospective multi-institutional cohort study. A logistic regression model was employed to develop a risk prediction model for AE.


A risk score (RS) was derived: 5 × (history of AE) + 4 × (surgical procedures) + 4 × (UIP appearance in CT scan) + 3 × (male sex) + 3 × (preoperative steroid use) + 2 × (elevated serum sialylated carbohydrate antigen, KL-6 level) + 1 × (low vital capacity). The RS was shown to be moderately discriminatory with a c-index of 0.709 and accurate with the Hosmer–Lemeshow goodness-of-fit test (p = 0.907). The patients were classified into three groups: low risk (RS: 0–10; predicted probability <0.1; n = 439), intermediate risk (RS: 11–14; predicted probability 0.1–0.25; n = 559), and high risk (RS: 15–22; predicted probability >0.25; n = 24).


Although further validation and refinement are needed, the risk score can be used in routine clinical practice to identify high risk individuals and to select proper treatment strategies.


Lung cancer surgery Post-operative morbidity Interstitial pneumonia 



We appreciate the investigators of the 64 institutions in Japan for laborious work to accumulate enormous amount of the records.

This work was supported by the Japan Intractable Disease Research Foundation of Japanese Ministry of Health and Welfare and the Japanese Association for Chest Surgery. No involvement of the funding resources in the design or conduct of this investigator-initiated study, data collection, management, analysis, or interpretation of the data, preparation, review, and approval of the manuscript, or decision to submit the manuscript. The authors had full control of the study design, methods, outcome variables, and results, data analysis, and manuscript production.

Conflict of interest

The authors have no conflict of interests that exist with any companies/organizations whose products or services may be discussed in this article.


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Copyright information

© The Japanese Association for Thoracic Surgery 2014

Authors and Affiliations

  • Toshihiko Sato
    • 1
  • Haruhiko Kondo
    • 2
  • Atsushi Watanabe
    • 3
  • Jun Nakajima
    • 4
  • Hiroshi Niwa
    • 5
  • Hirotoshi Horio
    • 6
  • Jiro Okami
    • 7
  • Norihito Okumura
    • 8
  • Kenji Sugio
    • 9
    • 10
  • Satoshi Teramukai
    • 11
  • Kazuma Kishi
    • 12
  • Masahito Ebina
    • 13
  • Yukihiko Sugiyama
    • 14
  • Takashi Kondo
    • 15
  • Hiroshi Date
    • 1
    Email author
  1. 1.Department of Thoracic SurgeryKyoto UniversityKyotoJapan
  2. 2.Department of Thoracic SurgeryKyorin University School of MedicineTokyoJapan
  3. 3.Department of Thoracic and Cardiovascular SurgerySapporo Medical University School of Medicine and HospitalSapporoJapan
  4. 4.Department of Thoracic SurgeryUniversity of Tokyo Graduate School of MedicineTokyoJapan
  5. 5.Division of Thoracic Surgery, Respiratory Disease CenterSeirei Mikatahara General HospitalHamamatsuJapan
  6. 6.Department of Thoracic SurgeryTokyo Metropolitan Cancer and Infectious Diseases Center Komagome HospitalTokyoJapan
  7. 7.Department of General Thoracic SurgeryOsaka Medical Center for Cancer and Cardiovascular DiseasesOsakaJapan
  8. 8.Department of Thoracic Surgery, Kurashiki Central HospitalKurashikiJapan
  9. 9.Department of Thoracic OncologyNational Kyushu Cancer CenterFukuokaJapan
  10. 10.Department of Thoracic and Breast SurgeryOita UniversityOitaJapan
  11. 11.Innovative Clinical Research CenterKanazawa UniversityKanazawaJapan
  12. 12.Department of Respiratory Medicine, Respiratory CenterToranomon HospitalTokyoJapan
  13. 13.Respiratory CenterTohoku Pharmaceutical University HospitalSendaiJapan
  14. 14.Department of Pulmonary MedicineJichi Medical UniversityTochigiJapan
  15. 15.Department of Thoracic Surgery, Institute of Development, Aging and CancerTohoku UniversitySendaiJapan

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