Fukui Mariko, Suzuki Kazuhiro, Ando Katsutoshi, Matsunaga Takeshi, Hattori Aritoshi, Takamochi Kazuya, Nojiri Shuko, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Department of Radiology, Juntendo University School of Medicine, Tokyo, Japan.
Lung Cancer. 2022 Mar;165:108-114. doi: 10.1016/j.lungcan.2021.12.018. Epub 2022 Jan 4.
To evaluate the surgical outcomes after surgery in patients with stage I lung cancer and idiopathic interstitial pneumonia (IIP).
This retrospective cohort study was conducted in 2131 patients with clinical stage I non-small-cell lung cancer (NSCLC) who underwent pulmonary resection between 2009 and 2018. Based on computed tomography (CT) findings, 233 patients had IIP. Lobectomy was performed in 180 patients with IIP and 1227 patients without IIP. Surgical outcomes, recurrence sites, and cause of death were investigated. In addition, we measured the distance between the tumor and hilum in patients with IIP and assessed the feasibility of sublobar resection.
The overall survival and cancer-specific survival of patients with IIP were significantly poorer than those of non-IIP patients. The five-year overall survival rates of patients with clinical stage IA/IB lung cancer with and without IIP were 58.1%/47.3% and 88.8%/68.9%, respectively. Furthermore, 9.4% of patients with IIP and 0.9% of patients without IIP died from respiratory-related causes within 2 years after surgery. Multivariate analyses revealed that volume capacity <80% (odds ratio: 3.259), usual interstitial pneumonia pattern by CT finding (odds ratio: 1.891), and nodal metastasis (odds ratio: 3.304) were prognostic factors for overall survival in patients with IIP. Unexpected nodal metastases were observed in 22.3% of patients with IIP. By CT judgment, sublobar resection was not feasible in 68% of patients with IIP who underwent lobectomy.
The overall survival of patients with early NSCLC after pulmonary resection with IIP was poor; this is related to the high prevalence of cancer-specific and respiratory-related deaths. Sublobar resection is not always feasible, the procedure on patients with IIP should be selected carefully according to the characteristics of each case. Nodal dissection should be performed to evaluate for metastasis, regardless of the extent of lung resection.
评估Ⅰ期肺癌合并特发性间质性肺炎（IIP）患者手术后的手术效果。
本回顾性队列研究纳入了2009年至2018年间接受肺切除术的2131例临床Ⅰ期非小细胞肺癌（NSCLC）患者。根据计算机断层扫描（CT）结果，233例患者患有IIP。180例IIP患者和1227例无IIP患者接受了肺叶切除术。对手术效果、复发部位和死亡原因进行了调查。此外，我们测量了IIP患者肿瘤与肺门之间的距离，并评估了亚肺叶切除的可行性。
IIP患者的总生存率和癌症特异性生存率显著低于非IIP患者。伴有和不伴有IIP的临床IA/IB期肺癌患者的五年总生存率分别为58.1%/47.3%和88.8%/68.9%。此外，9.4%的IIP患者和0.9%的无IIP患者在术后2年内死于呼吸相关原因。多因素分析显示，容积能力<80%（比值比：3.259）、CT表现为普通间质性肺炎模式（比值比：1.891）和淋巴结转移（比值比：3.304）是IIP患者总生存的预后因素。22.3%的IIP患者观察到意外的淋巴结转移。通过CT判断，68%接受肺叶切除术的IIP患者无法进行亚肺叶切除。
早期NSCLC合并IIP患者肺切除术后的总生存率较差；这与癌症特异性死亡和呼吸相关死亡的高发生率有关。亚肺叶切除并不总是可行的，应根据每个病例的特点仔细选择IIP患者的手术方式。无论肺切除范围如何，都应进行淋巴结清扫以评估有无转移。
