Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan.
Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka, Kiyose, Tokyo, 204-8585, Japan.
Gen Thorac Cardiovasc Surg. 2020 Sep;68(9):993-1002. doi: 10.1007/s11748-020-01326-1. Epub 2020 Mar 7.
As the number of patients with nontuberculous mycobacterial pulmonary disease (NTMPD) increases, surgical treatment to control disease becomes more important. However, postoperative outcomes and predictors of recurrence have been insufficiently evaluated.
We retrospectively investigated 100 patients with NTMPD who underwent pulmonary resection from 2009 to 2016 at our institution. Clinical data of patients with and without postoperative recurrence were statistically compared. Recurrence was defined as microbiological re-identification or computed tomography findings highly suspicious for relapse after excluding other diseases. Recurrence-free survival was calculated using the Kaplan-Meier method. Survival curves were compared using the log-rank test. Predictive factors were evaluated using univariate and multivariate analyses.
Nine patients experienced recurrence. A significant difference in recurrence-free survival was detected between patients with and without a positive preoperative sputum culture (P = 0.000942). Moreover, patients with a positive preoperative sputum smear (≥ 2 +) had a significantly higher recurrence rate than those who did not (P = 0.000216). Multivariate analysis revealed that preoperative sputum smear (≥ 2 +) is an independent risk factor for recurrence after pulmonary resection for NTMPD (odds ratio, 7.38; 95% confidential interval, 1.29-42.2; P = 0.024).
NTM discharge might have an impact on postoperative recurrence of NTMPD patients without residual cavitary lesions. Preoperative NTM discharge should be minimized by optimizing medical therapy before surgical treatment to improve the postoperative course. Intensive follow-up and prolonged postoperative medical therapy should be considered for patients without a sufficient reduction in bacterial discharge before pulmonary resection.
随着非结核分枝杆菌肺病（NTMPD）患者数量的增加，控制疾病的手术治疗变得更加重要。然而，术后结果和复发预测因素尚未得到充分评估。
我们回顾性调查了 2009 年至 2016 年在我院接受肺切除术的 100 例 NTMPD 患者。对有和无术后复发的患者的临床数据进行了统计学比较。复发定义为排除其他疾病后微生物学重新鉴定或高度怀疑复发的计算机断层扫描结果。使用 Kaplan-Meier 法计算无复发生存率。使用对数秩检验比较生存曲线。使用单因素和多因素分析评估预测因素。
9 例患者出现复发。术前痰培养阳性的患者与阴性的患者无复发生存率有显著差异（P=0.000942）。此外，术前痰涂片阳性（≥2+）的患者复发率明显高于阴性患者（P=0.000216）。多因素分析显示，术前痰涂片（≥2+）是 NTMPD 患者肺切除术后复发的独立危险因素（比值比，7.38；95%置信区间，1.29-42.2；P=0.024）。
NTM 排出物可能对无残留空洞病变的 NTMPD 患者的术后复发有影响。通过优化手术治疗前的药物治疗，尽量减少术前 NTM 排出物，可改善术后过程。对于术前细菌排出量未充分减少的患者，应考虑加强随访和延长术后药物治疗。
