Enomoto Yasunori, Inui Naoki, Kato Terufumi, Baba Tomohisa, Karayama Masato, Nakamura Yutaro, Ogura Takashi, Suda Takafumi
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Japan.
Lung Cancer. 2016 Jun;96:63-7. doi: 10.1016/j.lungcan.2016.03.017. Epub 2016 Mar 30.
Although acute exacerbation of pre-existing interstitial lung disease (AE-ILD) associated with cytotoxic chemotherapy has been recognized as a severe complication in lung cancer treatment, its risk factors have not been fully studied.
Among lung cancer patients receiving cytotoxic chemotherapy, patients with pre-existing ILD were identified based on the pretreatment high-resolution computed tomography (HRCT) findings. Chemotherapy-associated AE-ILD was defined as deterioration or development of dyspnea and HRCT findings of new bilateral ground-glass attenuations with/without non-segmental consolidation superimposed on pre-existing interstitial shadows, without evidence of pulmonary infection, congestion, or pulmonary embolism, within four weeks after the last administration of chemotherapy. Baseline characteristics were reviewed and the risk factors for chemotherapy-associated AE-ILD were evaluated by logistic regression analyses.
Among 85 patients identified as having pre-existing ILD, chemotherapy-associated AE-ILD occurred in 26 patients (30.6%); 8 patients died and 11 patients had a severely deteriorated general condition despite intensive treatment. Compared with those without AE-ILD, patients with AE-ILD had significantly lower forced vital capacity (FVC) (median: 91.1% versus 76.6%, P=0.01). Univariate and multivariate logistic regression analyses identified baseline lower FVC and non-small cell lung cancer (NSCLC) as the risk factors for this severe event (odds ratio of FVC: 0.97, 95% confidence interval: 0.94-0.99; odds ratio of NSCLC: 4.65, 95% confidence interval: 1.10-19.76).
Chemotherapy-associated AE-ILD was a frequent and lethal complication in lung cancer treatment for patients with pre-existing ILD. Spirometric assessment of pulmonary function may be useful to predict the event.
虽然与细胞毒性化疗相关的既往存在的间质性肺疾病急性加重（AE-ILD）已被认为是肺癌治疗中的一种严重并发症，但其危险因素尚未得到充分研究。
在接受细胞毒性化疗的肺癌患者中，根据治疗前高分辨率计算机断层扫描（HRCT）结果确定既往存在ILD的患者。化疗相关的AE-ILD定义为在最后一次化疗给药后四周内出现呼吸困难加重或新发，HRCT表现为新的双侧磨玻璃影伴/不伴非节段性实变叠加在既往存在的间质阴影上，且无肺部感染、充血或肺栓塞的证据。回顾基线特征，并通过逻辑回归分析评估化疗相关AE-ILD的危险因素。
在85例被确定为既往存在ILD的患者中，26例（30.6%）发生了化疗相关的AE-ILD；8例死亡，11例尽管接受了强化治疗但全身状况严重恶化。与无AE-ILD的患者相比，AE-ILD患者的用力肺活量（FVC）显著更低（中位数：91.1%对76.6%，P = 0.01）。单因素和多因素逻辑回归分析确定基线FVC较低和非小细胞肺癌（NSCLC）是这一严重事件的危险因素（FVC的比值比：0.97，95%置信区间：0.94 - 0.99；NSCLC的比值比：4.65，95%置信区间：1.10 - 19.76）。
化疗相关的AE-ILD是既往存在ILD的肺癌患者治疗中常见且致命的并发症。肺功能的肺活量测定评估可能有助于预测该事件。
