Miyajima Masahiro, Watanabe Atsushi, Sato Toshihiko, Teramukai Satoshi, Ebina Masahito, Kishi Kazuma, Sugiyama Yukihiko, Kondo Haruhiko, Kobayashi Satoru, Takahashi Yutaka, Ito Hiroyuki, Yamamoto Ryoji, Sawada Shigeki, Fujimori Hideki, Okabe Kazunori, Arikura Jun, Shintani Yasushi, Nakamura Hiroshige, Toyooka Shinichi, Hasumi Tohru, Watanabe Takehiro, Hata Yoshinobu, Iwata Hisashi, Aoki Minoru, Funai Kazuhito, Inoue Shuhei, Kawashima Osamu, Iida Tomohiko, Date Hiroshi
Department of Thoracic Surgery, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
Surg Today. 2018 Apr;48(4):404-415. doi: 10.1007/s00595-017-1605-8. Epub 2017 Nov 9.
Acute exacerbation of interstitial pneumonia (AEIP) is a leading cause of death after lung cancer resection in patients with interstitial lung disease.
We retrospectively analyzed 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease (ILD) who underwent lung cancer resection between 2000 and 2009 at 61 hospitals in Japan. AEIP occurred in 164 of 1763 (9.3%) patients with a mortality rate of 43.9% (72/164). Univariate and multivariate analyses were carried out to identify possible risk factors of fatal AEIP. We then analyzed the 164 patients who developed postoperative AEIP and identified the preoperative and postoperative risk factors.
A multivariate regression analysis identified that the sex, percent vital capacity, neoadjuvant radiation, preoperative history of AEIP, preoperative use of steroids, usual interstitial pneumonia pattern on CT, and surgical procedures were independent preoperative risk factors for death due to AEIP. ILD patients with emphysema somehow showed a lower risk of fatal AEIP than those without emphysema in this study.
This study revealed eight risk factors for fatal AEIP.
间质性肺炎急性加重（AEIP）是间质性肺疾病患者肺癌切除术后的主要死亡原因。
我们回顾性分析了2000年至2009年间在日本61家医院接受肺癌切除术、临床诊断为间质性肺疾病（ILD）的1763例非小细胞肺癌患者。1763例患者中有164例（9.3%）发生AEIP，死亡率为43.9%（72/164）。进行单因素和多因素分析以确定致命性AEIP的可能危险因素。然后我们分析了164例发生术后AEIP的患者，并确定术前和术后的危险因素。
多因素回归分析确定，性别、肺活量百分比、新辅助放疗、术前AEIP病史、术前使用类固醇、CT上的普通间质性肺炎模式和手术方式是AEIP导致死亡的独立术前危险因素。在本研究中，合并肺气肿的ILD患者发生致命性AEIP的风险似乎低于未合并肺气肿的患者。
本研究揭示了致命性AEIP的八个危险因素。
