First Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Respiration. 2017;94(2):198-206. doi: 10.1159/000477587. Epub 2017 Jun 22.
It remains unclear whether the preoperative pulmonary function parameters and prognostic indices that are indicative of nutritional and immunological status are associated with prognosis in lung cancer patients with combined pulmonary fibrosis and emphysema (CPFE) who have undergone surgery.
The aim of this study is to identify prognostic determinants in these patients.
The medical records of all patients with lung cancer associated with CPFE who had undergone surgery at Shinshu University Hospital were retrospectively reviewed to obtain clinical data, including the results of preoperative pulmonary function tests and laboratory examinations, chest high-resolution computed tomography (HRCT), and survival.
Univariate Cox proportional hazards regression analysis showed that a high pathological stage of the lung cancer, a higher preoperative serum carcinoembryonic antigen level, and a higher preoperative composite physiologic index (CPI) were associated with a high risk of death. Multivariate analysis showed that a high pathological stage of the lung cancer (HR: 1.579; p = 0.0305) and a higher preoperative CPI (HR: 1.034; p = 0.0174) were independently associated with a high risk of death. In contrast, the severity of fibrosis or emphysema on chest HRCT, the individual pulmonary function parameters, the prognostic nutritional index, the neutrophil-to-lymphocyte ratio, and the platelet-to-lymphocyte ratio were not associated with prognosis. In the Kaplan-Meier analysis, the log-rank test showed significant differences in survival between the high-CPI and the low-CPI group (p = 0.0234).
The preoperative CPI may predict mortality and provide more powerful prognostic information than individual pulmonary function parameters in lung cancer patients with CPFE who have undergone surgery.
对于合并肺纤维化和肺气肿（CPFE）的肺癌患者，手术前能够反映营养和免疫状态的肺功能参数和预后指标是否与预后相关，目前尚不清楚。
本研究旨在确定这些患者的预后决定因素。
回顾性分析在日本信州大学医院接受手术治疗的 CPFE 相关肺癌患者的病历资料，获取临床资料，包括术前肺功能检查和实验室检查结果、胸部高分辨率计算机断层扫描（HRCT）和生存情况。
单因素 Cox 比例风险回归分析显示，肺癌的较高病理分期、术前血清癌胚抗原水平较高和术前复合生理指数（CPI）较高与死亡风险较高相关。多因素分析显示，肺癌的较高病理分期（HR：1.579；p = 0.0305）和较高的术前 CPI（HR：1.034；p = 0.0174）与死亡风险增加独立相关。相比之下，胸部 HRCT 上纤维化或肺气肿的严重程度、单个肺功能参数、预后营养指数、中性粒细胞与淋巴细胞比值和血小板与淋巴细胞比值与预后无关。在 Kaplan-Meier 分析中，对数秩检验显示高 CPI 组和低 CPI 组的生存差异有统计学意义（p = 0.0234）。
术前 CPI 可能预测死亡率，并为接受手术治疗的 CPFE 相关肺癌患者提供比单个肺功能参数更有力的预后信息。
