Thoracic Surgery Unit, University Hospital of Siena, Siena, Italy.
Eur J Cardiothorac Surg. 2013 Jan;43(1):e17-23. doi: 10.1093/ejcts/ezs560. Epub 2012 Nov 4.
The study aimed to determine the impact of interstitial lung disease (ILD) on postoperative morbidity, mortality and long-term survival of patients with non-small-cell lung cancer (NSCLC) undergoing pulmonary resection.
We performed a retrospective chart review of 775 consecutive patients who had undergone lung resection for NSCLC between 2000 and 2009. ILD, defined by medical history, physical examination and abnormalities compatible with bilateral lung fibrosis on high-resolution computed tomography, was diagnosed in 37 (4.8%) patients (ILD group). The remaining 738 patients were classified as non-ILD (control group). We also attempted to identify the predictive factors for early and late survival in patients with ILD following pulmonary resection.
There was no significant difference between the two groups in terms of age (69 vs 66 years), sex (79 vs 72% male), smoking history (93 vs 90% smokers), forced expiratory volume in 1 s % of predicted (89 vs 84%), predicted values of forced vital capacity (FVC)% (92 vs 94%), types of surgical resection and histology. Patients with ILD had a higher incidence of postoperative acute respiratory distress syndrome (ARDS; 13 vs 1.8%, P < 0.01) and higher postoperative mortality (8 vs 1.4%, P < 0.01). The overall 5-year survival rate was 52% in the ILD and 65% in the non-ILD patients, respectively (P = 0.019). In the ILD group, at the median follow-up of 26 months (range 4-119), 19 (51%) patients were still alive and 18 (49%) had died in the ILD group. The major cause of late death was respiratory failure due to the progression of fibrosis (n = 7, 39%). In the ILD group, lower preoperative FVC% (mean 77 vs 93%, P < 0.01) and lower diffusing capacity of the lung for carbon monoxide (DLCO%; 47 vs 62%; P < 0.01) were significantly associated with postoperative ARDS.
In conclusion, major lung resection in patients with NSCLC and ILD is associated with an increased postoperative morbidity and mortality. Patients with a low preoperative FVC% should be carefully assessed prior to undergoing surgery, particularly in the presence of a lower DLCO%. Long-term survival is significantly lower when compared with patients without ILD, but still achievable in a substantial subgroup. Thus, surgery can be offered to properly selected patients with lung cancer and ILD, keeping in mind the risk of respiratory failure during the evaluation of such patients.
本研究旨在确定间质性肺病（ILD）对行肺切除术的非小细胞肺癌（NSCLC）患者术后发病率、死亡率和长期生存的影响。
我们对 2000 年至 2009 年间行肺切除术的 775 例连续 NSCLC 患者进行了回顾性图表审查。ILD 通过病史、体格检查以及高分辨率计算机断层扫描显示双侧肺纤维化的异常来诊断，共有 37 例（4.8%）患者被诊断为ILD（ILD 组）。其余 738 例患者被归类为非ILD（对照组）。我们还试图确定ILD 患者肺切除术后早期和晚期生存的预测因素。
两组在年龄（69 岁与 66 岁）、性别（79%与 72%男性）、吸烟史（93%与 90%吸烟者）、1 秒用力呼气量占预计值的百分比（89%与 84%）、用力肺活量预计值的百分比（92%与 94%）、手术切除类型和组织学方面无显著差异。ILD 患者术后急性呼吸窘迫综合征（ARDS；13%与 1.8%，P<0.01）和术后死亡率（8%与 1.4%，P<0.01）较高。ILD 组的总 5 年生存率为 52%，非ILD 组为 65%（P=0.019）。在ILD 组中，中位随访 26 个月（范围 4-119 个月），19 例（51%）患者仍存活，18 例（49%）患者死亡。晚期死亡的主要原因是纤维化进展导致的呼吸衰竭（n=7，39%）。ILD 组术前用力肺活量（FVC）%较低（平均 77%与 93%，P<0.01），一氧化碳弥散量（DLCO）%较低（47%与 62%，P<0.01），与术后 ARDS 显著相关。
总之，NSCLC 合并ILD 患者行肺切除术与术后发病率和死亡率增加相关。术前 FVC%较低的患者应在手术前进行仔细评估，特别是在 DLCO%较低的情况下。与无ILD 的患者相比，ILD 患者的长期生存率显著降低，但在相当一部分亚组中仍然可以实现。因此，对于适当选择的肺癌合并ILD 患者，可以考虑手术，但在评估此类患者时需要考虑呼吸衰竭的风险。
