Goto Taichiro, Maeshima Arafumi, Oyamada Yoshitaka, Kato Ryoichi
Department of General Thoracic Surgery, National Hospital Organization Tokyo Medical Center, Meguro-ku, Tokyo, 152-8902, Japan,
Int J Clin Oncol. 2014 Apr;19(2):266-73. doi: 10.1007/s10147-013-0566-1. Epub 2013 May 10.
We investigated the postoperative mortality and long-term survival of lung cancer patients with underlying idiopathic pulmonary fibrosis (IPF).
The data of 387 primary lung cancer patients treated by surgical resection at our hospital between 1995 and 2008 were retrospectively reviewed. Clinicopathological characteristics such as age, gender, survival, presence/absence of underlying IPF, atypical adenomatous hyperplasia (AAH), and the associations among these factors were examined.
Among the 387 patients, 65 (16.8 %) had underlying IPF as detected by histopathology of the resected specimen (IPF group). The percentages of men and squamous cell carcinomas were significantly higher in the IPF group. None of our patients showed concomitant presence of AAH and IPF. Four of the 65 patients showed acute exacerbation of the IPF postoperatively, and all 4 of these patients died in hospital. In patients with non-small cell lung carcinoma, the postoperative survival tended to be lower in the IPF group than in the non-IPF group. Analysis using a Cox proportional hazards model by disease stage revealed that presence of underlying IPF was a risk factor for postoperative mortality in patients with pathological stage I/II but not for stage III/IV. Respiratory failure was the second main cause of death in the stage I/II lung cancer patients of the IPF group.
Histopathological evidence of IPF was a risk factor for postoperative mortality and poor long-term survival, especially in patients with stage I/II non-small cell lung cancer, with postoperative respiratory failure representing the major cause of death.
我们研究了合并特发性肺纤维化（IPF）的肺癌患者的术后死亡率和长期生存率。
回顾性分析了1995年至2008年在我院接受手术切除的387例原发性肺癌患者的数据。检查了年龄、性别、生存情况、是否存在潜在IPF、非典型腺瘤样增生（AAH）等临床病理特征以及这些因素之间的关联。
在387例患者中，65例（16.8%）经切除标本的组织病理学检查发现存在潜在IPF（IPF组）。IPF组男性和鳞状细胞癌的比例明显更高。我们的患者中没有同时存在AAH和IPF的情况。65例患者中有4例术后出现IPF急性加重，这4例患者均在医院死亡。在非小细胞肺癌患者中，IPF组的术后生存率往往低于非IPF组。按疾病分期使用Cox比例风险模型分析显示，存在潜在IPF是病理分期为I/II期患者术后死亡的危险因素，但不是III/IV期患者的危险因素。呼吸衰竭是IPF组I/II期肺癌患者的第二大主要死因。
IPF的组织病理学证据是术后死亡和长期生存不良的危险因素，尤其是在I/II期非小细胞肺癌患者中，术后呼吸衰竭是主要死因。
