Tamura Atsuhisa, Suzuki Junko, Fukami Takeshi, Matsui Hirotoshi, Akagawa Shinobu, Ohta Ken, Hebisawa Akira, Takahashi Fumiaki
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan Clinical Research Center, Pathology and Epidemiology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Interact Cardiovasc Thorac Surg. 2015 Nov;21(5):650-6. doi: 10.1093/icvts/ivv239. Epub 2015 Aug 30.
Chronic pulmonary aspergillosis (CPA) is an emerging complication after lobectomy for lung cancer. This retrospective study aimed to determine the incidence, main risk factors and clinical features of postoperative CPA in lung cancer patients.
This study included lung cancer patients treated by lobectomy and with no previous history of thoracic surgery or coexistent aspergillosis at the time of surgery. The cumulative incidence of CPA was determined using death as a competing risk. Furthermore, the identified lung cancer patients were divided into CPA and non-CPA groups to compare their preoperative clinical features and to identify the risk factors of postoperative CPA by univariable and multivariable analyses. We also analysed the clinical features of CPA patients after diagnosis.
We included 475 lung cancer patients. Of these, 17 patients (3.6%) developed CPA after the lobectomy. The cumulative postoperative incidence rate of CPA was 2.3% [95% confidence interval (CI), 0.8-3.8%] at 5 years and 7.9% (95% CI, 3.0-13.0%) at 10 years. There were significantly more men (P = 0.007), smokers (P = 0.002) and comorbid chronic obstructive pulmonary disease (COPD) (P = 0.008) and interstitial lung disease (ILD) (P = 0.009) patients in the CPA group than in the non-CPA group. Multivariable analysis identified comorbid COPD (P = 0.0019) and ILD (P = 0.0003) as significant risk factors. An antifungal treatment response was obtained in 6 patients (35%). The 1-year survival rate was 47% (follow-up periods, interquartile range: 3-78 months), and 5 of the total of 11 deaths were due to CPA.
Through the present retrospective study, CPA seems to be a common sequel to lobectomy in lung cancer patients, and COPD and ILD represent strong risk factors of postoperative CPA. Because of the poor clinical outcome of lung cancer patients who develop CPA after lobectomy, careful follow-up using several examinations and chest radiographs to make CPA diagnosis may be essential.
慢性肺曲霉病（CPA）是肺癌肺叶切除术后新出现的一种并发症。本回顾性研究旨在确定肺癌患者术后CPA的发生率、主要危险因素及临床特征。
本研究纳入接受肺叶切除术且术前无胸外科手术史或手术时无合并曲霉病的肺癌患者。以死亡作为竞争风险来确定CPA的累积发生率。此外，将纳入的肺癌患者分为CPA组和非CPA组，比较其术前临床特征，并通过单变量和多变量分析确定术后CPA的危险因素。我们还分析了CPA患者确诊后的临床特征。
我们纳入了475例肺癌患者。其中，17例（3.6%）在肺叶切除术后发生了CPA。CPA术后累积发生率在5年时为2.3%[95%置信区间（CI），0.8 - 3.8%]，10年时为7.9%（95%CI，3.0 - 13.0%）。CPA组男性（P = 0.007）、吸烟者（P = 0.002）、合并慢性阻塞性肺疾病（COPD）（P = 0.008）和间质性肺疾病（ILD）（P = 0.009）的患者显著多于非CPA组。多变量分析确定合并COPD（P = 0.0019）和ILD（P = 0.0003）为显著危险因素。6例患者（35%）获得了抗真菌治疗反应。1年生存率为47%（随访期，四分位间距：3 - 78个月），11例死亡患者中有5例死于CPA。
通过本回顾性研究，CPA似乎是肺癌患者肺叶切除术后常见的后遗症，COPD和ILD是术后CPA的重要危险因素。由于肺叶切除术后发生CPA的肺癌患者临床结局较差，采用多种检查和胸部X线片进行仔细随访以诊断CPA可能至关重要。
