Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
BMJ Open Respir Res. 2023 Mar;10(1). doi: 10.1136/bmjresp-2022-001529.
Patients with lung cancer with underlying idiopathic pulmonary fibrosis and usual interstitial pneumonia (UIP) pattern on CT represent a very high-risk group in terms of postoperative UIP acute exacerbations (AEs) and in-hospital mortality. We sought to investigate the outcomes in these patients.
We carried out a meta-analysis, searching four international databases from 1 January 1947 to 27 April 2022, for studies in any language reporting on the acute postoperative outcomes of patients with lung cancer undergoing surgical resection with underlying UIP (the primary outcome). Random effects meta-analyses (DerSimonian and Laird) were conducted. We analysed the difference in incidence of postoperative AE as well as the difference in long-term overall survival among subpopulations. These were stratified by the extent of surgical resection, with meta-regression testing (uniivariate and multivariate) according to the stage of disease, operative decision making and country of origin. This study was registered with PROSPERO (CRD42022319245).
The overall incidence of AE of UIP postoperatively from 10 studies (2202 patients) was 14.6% (random effects model, 95% CI 9.8 to 20.1, I=74%). Sublobar resection was significantly associated with a reduced odds of postoperative AE (OR 0.521 (fixed effects model), 95% CI 0.339 to 0.803, p=0.0031, I=0%). The extent of resection was not significantly associated with overall survival following lung cancer resection in UIP patients (HR for sublobar resection 0.978 (random effects model), 95% CI 0.521 to 1.833, p=0.9351, I=71%).
With appropriate implementation of perioperative measures such as screening for high-risk cases, appropriate use of steroids, antifibrotics and employing sublobar resection in select cases, the risk of local recurrence versus in-hospital mortality from AEUIP can be balanced and long-term survival can be achieved in a super-selected group of patients. Further investigation in the form of a randomised study is warranted.
CT 上表现为特发性肺纤维化和常见间质性肺炎（UIP）模式的肺癌伴肺纤维化患者，在术后 UIP 急性加重（AE）和住院死亡率方面属于极高风险组。我们旨在研究这些患者的结局。
我们进行了一项荟萃分析，从 1947 年 1 月 1 日至 2022 年 4 月 27 日，在四个国际数据库中，以任何语言检索报告接受肺癌切除术且存在 UIP （主要结局）的患者术后急性结局的研究。采用随机效应荟萃分析（DerSimonian 和 Laird）。我们分析了术后 AE 的发生率差异以及亚组人群的长期总生存率差异。根据手术切除范围进行分层，根据疾病分期、手术决策和来源国进行单变量和多变量meta 回归检验。本研究已在 PROSPERO（CRD42022319245）上注册。
10 项研究（2202 例患者）的 UIP 术后 AE 总体发生率为 14.6%（随机效应模型，95%CI 9.8%至 20.1%，I=74%）。亚肺叶切除术与术后 AE 发生的可能性降低显著相关（OR 0.521（固定效应模型），95%CI 0.339 至 0.803，p=0.0031，I=0%）。UIP 患者肺癌切除术后，切除范围与总生存率无显著相关性（亚肺叶切除术的 HR 为 0.978（随机效应模型），95%CI 0.521 至 1.833，p=0.9351，I=71%）。
通过实施围手术期措施，如高危病例筛查、合理使用类固醇、抗纤维化药物以及在特定情况下采用亚肺叶切除术，可以平衡局部复发与 UIP 术后急性加重的院内死亡率，从而使一组超选患者获得长期生存。需要进一步开展随机研究。
