Sekihara Keigo, Aokage Keiju, Miyoshi Tomohiro, Tane Kenta, Ishii Genichiro, Tsuboi Masahiro
Division of Thoracic Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa, Chiba, Japan.
Course of Advanced Clinical Research of Cancer, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
Surg Today. 2020 Aug;50(8):905-911. doi: 10.1007/s00595-020-01978-9. Epub 2020 Mar 6.
Lung cancer in patients with idiopathic pulmonary fibrosis (IPF) is associated with a poor prognosis and postoperative acute exacerbation (AE) of IPF is a fatal complication. Studies have shown that perioperative pirfenidone treatment (PPT) may reduce the incidence of AE-IPF. We evaluated the efficacy of PPT in preventing AE-IPF and improving overall survival.
The subjects of this study were 56 patients with IPF who underwent resection of lung cancer in our hospital between January, 2011 and September, 2016. Pirfenidone was administered to patients from 4 weeks before the operation and continued for longer periods. Thirty-six patients received PPT and their outcome was compared with that of the other 20 patients who did not.
There were no differences in age, gender, smoking history, respiratory function, or surgical procedures between the groups. AE-IPF developed in three patients (8%) in the PPT group and four (20%) patients in the non-PPT group, without a significant difference between the groups. The interval was significantly longer in the PPT group (p = 0.03). PPT reduced postoperative mortality significantly (p = 0.04).
Although perioperative pirfenidone treatment did not obviously prevent postoperative AE-IPF, it may reduce the mortality of lung cancer patients with IPF.
特发性肺纤维化（IPF）患者的肺癌预后较差，IPF术后急性加重（AE）是一种致命并发症。研究表明，围手术期使用吡非尼酮治疗（PPT）可能降低AE-IPF的发生率。我们评估了PPT在预防AE-IPF和改善总生存率方面的疗效。
本研究的对象为2011年1月至2016年9月在我院接受肺癌切除术的56例IPF患者。患者在手术前4周开始服用吡非尼酮，并持续较长时间。36例患者接受了PPT，并将其结果与另外20例未接受PPT的患者进行比较。
两组患者在年龄、性别、吸烟史、呼吸功能或手术方式方面无差异。PPT组有3例患者（8%）发生AE-IPF，非PPT组有4例患者（20%）发生AE-IPF，两组之间无显著差异。PPT组的间隔时间明显更长（p = 0.03）。PPT显著降低了术后死亡率（p = 0.04）。
虽然围手术期使用吡非尼酮治疗并不能明显预防术后AE-IPF，但它可能降低IPF肺癌患者的死亡率。
