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What factors determine the survival of patients with an acute exacerbation of interstitial lung disease after lung cancer resection?

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Abstract

Purposes

Acute exacerbation of interstitial pneumonia (AEIP) is a leading cause of death after lung cancer resection in patients with interstitial lung disease.

Methods

We retrospectively analyzed 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease (ILD) who underwent lung cancer resection between 2000 and 2009 at 61 hospitals in Japan. AEIP occurred in 164 of 1763 (9.3%) patients with a mortality rate of 43.9% (72/164). Univariate and multivariate analyses were carried out to identify possible risk factors of fatal AEIP. We then analyzed the 164 patients who developed postoperative AEIP and identified the preoperative and postoperative risk factors.

Results

A multivariate regression analysis identified that the sex, percent vital capacity, neoadjuvant radiation, preoperative history of AEIP, preoperative use of steroids, usual interstitial pneumonia pattern on CT, and surgical procedures were independent preoperative risk factors for death due to AEIP. ILD patients with emphysema somehow showed a lower risk of fatal AEIP than those without emphysema in this study.

Conclusions

This study revealed eight risk factors for fatal AEIP.

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Fig. 1: The overall survival.
Fig. 2: The overall survival after overcoming AEIP.

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Abbreviations

IIP:

Idiopathic interstitial pneumonia

IPF:

Idiopathic pulmonary fibrosis

AEIP:

Acute exacerbation of interstitial pneumonia

KL-6:

Sialylated carbohydrate antigen KL-6

UIP:

Usual interstitial pneumonia

ILD:

Interstitial lung disease

CT:

Computed tomography

CRP:

Serum C-reactive protein

LDH:

Lactate dehydrogenase

CEA:

Carcinoembryonic antigen

%VC:

Percent vital capacity

FEV1%:

Percent forced expiratory volume in 1 s

VATS:

Video-assisted thoracoscopic surgery

CTx:

Chemotherapy

RTx:

Radiotherapy

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Acknowledgements

We thank Ms. Tomoko Sonoda of Sapporo Medical University and Ms. Tomomi Sakabayashi of Kyoto Prefectural University of Medicine for their contribution to the statistical analysis and assessment of the patients’ clinical data.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan

    Masahiro Miyajima & Atsushi Watanabe

  2. Department of Thoracic Surgery, Kyoto University, Kyoto, Japan

    Toshihiko Sato & Hiroshi Date

  3. Department of Biostatistics, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan

    Satoshi Teramukai

  4. Respiratory Center, Tohoku Pharmaceutical University Hospital, Sendai, Japan

    Masahito Ebina

  5. Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan

    Kazuma Kishi

  6. Department of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan

    Yukihiko Sugiyama

  7. Department of Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan

    Haruhiko Kondo

  8. Department of General Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan

    Satoru Kobayashi

  9. Department of Respiratory Surgery, Kobe City Medical Centre General Hospital, Kobe, Japan

    Yutaka Takahashi

  10. Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan

    Hiroyuki Ito

  11. Department of General Thoracic Surgery, Osaka City General Hospital, Osaka, Japan

    Ryoji Yamamoto

  12. Department of Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

    Shigeki Sawada

  13. Department of General Thoracic Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan

    Hideki Fujimori

  14. Division of Thoracic Surgery, National Hospital Organization Yamaguchi–Ube Medical Center, Ube, Japan

    Kazunori Okabe

  15. Department of Chest Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan

    Jun Arikura

  16. Department of General Thoracic Surgery, Osaka University, Osaka, Japan

    Yasushi Shintani

  17. Division of General Thoracic Surgery, Tottori University Hospital, Yonago, Japan

    Hiroshige Nakamura

  18. Department of Thoracic, Breast and Endocrinological Surgery, Okayama University, Okayama, Japan

    Shinichi Toyooka

  19. Department of Thoracic Surgery, Tohoku University Hospital, Sendai, Japan

    Tohru Hasumi

  20. Department of Chest Surgery, National Hospital Organization Nishi-Niigata Chuo National Hospital, Nigata, Japan

    Takehiro Watanabe

  21. Department of Surgery, Toho University School of Medicine, Tokyo, Japan

    Yoshinobu Hata

  22. Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, Gifu, Japan

    Hisashi Iwata

  23. Department of Thoracic Surgery, Nishi-Kobe Medical Center, Kobe, Japan

    Minoru Aoki

  24. First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

    Kazuhito Funai

  25. Department of General Thoracic Surgery, National Hospital Organization Higashi-Ohmi General Medical Center, Higashi-Ohmi, Japan

    Shuhei Inoue

  26. Department of Thoracic Surgery, National Hospital Organization Nishigunma National Hospital, Gunma, Japan

    Osamu Kawashima

  27. Department of General Thoracic Surgery, Kimitsu Central Hospital, Chiba, Japan

    Tomohiko Iida

Authors
  1. Masahiro Miyajima
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  2. Atsushi Watanabe
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  18. Hiroshige Nakamura
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  28. Tomohiko Iida
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  29. Hiroshi Date
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Corresponding author

Correspondence to Masahiro Miyajima.

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Conflict of interest statement

Masahiro Miyajima and the other co-authors have no conflicts of interest to declare in association with this study.

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Miyajima, M., Watanabe, A., Sato, T. et al. What factors determine the survival of patients with an acute exacerbation of interstitial lung disease after lung cancer resection?. Surg Today 48, 404–415 (2018). https://doi.org/10.1007/s00595-017-1605-8

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  • DOI: https://doi.org/10.1007/s00595-017-1605-8

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