Mimae Takahiro, Suzuki Kenji, Tsuboi Masahiro, Nagai Kanji, Ikeda Norihiko, Mitsudomi Tetsuya, Saji Hisashi, Okumura Sakae, Okumura Meinoshin, Yoshimura Kenichi, Okada Morihito
Department of Surgical Oncology, Hiroshima University, Minami-ku, Hiroshima, Japan.
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Ann Surg Oncol. 2015 Dec;22 Suppl 3:S1371-9. doi: 10.1245/s10434-015-4577-1. Epub 2015 May 9.
Lung cancers in patients with combined pulmonary fibrosis and emphysema (CPFE) are increasing. Objective of this investigation was to identify which clinicopathological features significantly affected surgical outcome of these patients.
Among 4313 patients with primary lung cancers who underwent surgery between January 2008 and December 2010 in nine institutions in Japan, 265 had CPFE. We retrospectively compared 2176 and 157 patients without and with CPFE, respectively, and further analyzed 233 patients with CPFE whose detailed information was available. CPFE was defined as upper lobe emphysema and lower lobe fibrosis.
The rates of postoperative morbidity and mortality were higher and overall survival was poorer in patients with, than without CPFE. Among 233 patients with CPFE, the median values of %VC and FEV1.0 % were 98.4 and 71.5 %, respectively. The histological types comprised 111 squamous cell carcinomas and 84 adenocarcinomas. Surgical procedures included 203 standard lobectomies/pneumonectomies and 30 lesser resections. Five patients (2 %) developed postoperative acute exacerbation of interstitial pneumonia. Six and 15 patients (3 and 6 %) died within 30- and 90-postoperative-day, respectively. Cancer was the cause of death at 90-day in only one patient. The 3-year overall survival rate for all patients was 58.4 %. Multivariate analysis showed that male sex, advanced age, advanced clinical stage and lower %VC predict a poor prognosis.
Patients with lung cancer and CPFE had poor prognoses regardless of apparently good pulmonary function and showed quite high postoperative mortality rates. A lower %VC that might reflect the severity of pulmonary fibrosis was associated with poor prognoses.
合并肺纤维化和肺气肿（CPFE）患者的肺癌发病率正在上升。本研究的目的是确定哪些临床病理特征会显著影响这些患者的手术结果。
在2008年1月至2010年12月期间于日本9家机构接受手术的4313例原发性肺癌患者中，265例患有CPFE。我们分别对2176例无CPFE患者和157例有CPFE患者进行了回顾性比较，并进一步分析了233例有详细信息的CPFE患者。CPFE定义为上叶肺气肿和下叶纤维化。
与无CPFE患者相比，有CPFE患者的术后发病率和死亡率更高，总生存率更差。在233例CPFE患者中，%VC和FEV1.0%的中位数分别为98.4%和71.5%。组织学类型包括111例鳞状细胞癌和84例腺癌。手术方式包括203例标准肺叶切除术/全肺切除术和30例次全肺切除术。5例（2%）患者术后发生间质性肺炎急性加重。分别有6例（3%）和15例（6%）患者在术后30天和90天内死亡。仅1例患者在术后90天死于癌症。所有患者的3年总生存率为58.4%。多因素分析显示，男性、高龄、临床分期较晚和%VC较低预示预后不良。
肺癌合并CPFE患者无论肺功能表面上是否良好，预后均较差，术后死亡率相当高。较低的%VC可能反映肺纤维化的严重程度，与预后不良相关。
