Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620971137. doi: 10.1177/1753466620971137.
Interstitial lung disease (ILD) is associated with the incidence of non-small cell lung cancer (NSCLC). Patients with ILD are at risk of acute exacerbation (AE) after pulmonary resection. However, there have been no recognized treatment guidelines for NSCLC patients with ILD on computed tomography (CT).
We reviewed the medical records of 156 consecutive patients with ILD on high-resolution CT who have undergone pulmonary resection and between 2014 and 2018. Data regarding general information, imaging features, perioperative indicators, and long-term prognosis of patients were compared.
The mean patient age was 67.24 ± 6.80 years. Postoperative AE occurred in seven (4.5%) patients; five (71.4%) of the seven patients who had an AE died within 30 days. The incidence of postoperative AE was 5.3% among patients who underwent lobectomy ( = 6). Overall survivals (OS) was significantly poorer in patients with possible usual interstitial pneumonia (UIP)/UIP [hazard ratio (HR) 2.34, 95% confidence interval (CI) 1.11-4.95, = 0.026] and severe postoperative complications (Grade ⩾3) ( no complication: HR 2.58, 95% CI 1.11-6.02, = 0.028; mild complications: HR 6.05, 95% CI 2.69-13.6, < 0.001). Age (HR 1.071, 95% CI 1.006-1.137, = 0.030) and ILD patterns (HR 2.420, 95% CI 1.024-5.716, = 0.044) were independent prognostic factors for OS. Forced vital capacity (FVC) (odds ratio 0.351, 95% CI 0.145-0.850, = 0.020) was an independent prognostic factor for patients who needed postoperative intensive care unit intervention.
Pulmonary resection for NSCLC Patients with ILD on CT is a safe procedure. However, surgical indications for lobectomy need to be more carefully for these patients, especially for possible UIP/UIP patients and patients with lower FVC.
间质性肺疾病（ILD）与非小细胞肺癌（NSCLC）的发病率有关。接受肺切除术的患者有发生急性加重（AE）的风险。然而，对于 CT 上有 ILD 的 NSCLC 患者，尚无公认的治疗指南。
我们回顾了 2014 年至 2018 年间在高分辨率 CT 上接受肺切除术的 156 例 ILD 连续患者的病历。比较了患者的一般信息、影像学特征、围手术期指标和长期预后数据。
患者平均年龄为 67.24±6.80 岁。7 例（4.5%）患者术后发生 AE，其中 5 例（71.4%）AE 患者在 30 天内死亡。行肺叶切除术的患者中术后 AE 的发生率为 5.3%（n=6）。可能为普通间质性肺炎（UIP）/UIP 的患者的总体生存率（OS）明显较差[风险比（HR）2.34，95%置信区间（CI）1.11-4.95，p=0.026]和严重术后并发症（等级≥3）（无并发症：HR 2.58，95%CI 1.11-6.02，p=0.028；轻度并发症：HR 6.05，95%CI 2.69-13.6，p<0.001）。年龄（HR 1.071，95%CI 1.006-1.137，p=0.030）和ILD 模式（HR 2.420，95%CI 1.024-5.716，p=0.044）是 OS 的独立预后因素。用力肺活量（FVC）（比值比 0.351，95%CI 0.145-0.850，p=0.020）是需要术后重症监护干预的患者的独立预后因素。
CT 上有 ILD 的 NSCLC 患者接受肺切除术是安全的。然而，对于这些患者，肺叶切除术的手术适应证需要更加谨慎，特别是对于可能的 UIP/UIP 患者和 FVC 较低的患者。
