间质性肺病与肺癌切除术后结局的关系。
Association Between Interstitial Lung Disease and Outcomes After Lung Cancer Resection.
机构信息
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
Section of Thoracic Surgery, University of Colorado Hospital, Aurora, Colorado.
出版信息
Ann Thorac Surg. 2023 Sep;116(3):533-541. doi: 10.1016/j.athoracsur.2023.04.042. Epub 2023 Jun 2.
BACKGROUND
Prior studies have noted that patients with interstitial lung disease (ILD) possess an increased incidence of lung cancer and risk of postoperative respiratory failure and death. We sought to understand the impact of ILD on national-scale outcomes of lung resection.
METHODS
A retrospective cohort analysis using The Society of Thoracic Surgeons General Thoracic Surgery Database was conducted of patients who underwent a pulmonary resection for non-small cell lung cancer between 2009 and 2019. Baseline characteristics and postoperative outcomes were compared between patients with and without ILD (defined as interstitial fibrosis based on clinical, radiographic, or pathologic evidence). Multivariable logistic regression models identified risk factors associated with postoperative mortality, acute respiratory distress syndrome, and composite morbidity and mortality.
RESULTS
ILD was documented in 1.5% (1873 of 128,723) of patients who underwent a pulmonary resection for non-small cell lung cancer. Patients with ILD were more likely to smoke (90% vs 85%, P < .001), have pulmonary hypertension (6% vs 1.7%, P < .001), impaired diffusing capacity of lung for carbon monoxide (diffusing capacity of lung for carbon monoxide 40%-75%: 64% vs 51%; diffusing capacity of lung for carbon monoxide <40%: 11% vs 4%, P < .001), and undergo more sublobar resections (34% vs 23%, P < .001) compared with patients without ILD. Patients with ILD had increased postoperative mortality (5.1% vs 1.2%, P < .001), acute respiratory distress syndrome (1.9% vs 0.5%, P < .001), and composite morbidity and mortality (13.2% vs 7.4%, P < .001). ILD remained a strong predictor of mortality (odds ratio, 3.94; 95% CI, 3.09-5.01; P < .001), even when adjusted for patient comorbidities, pulmonary function, extent of resection, and center volume effects.
CONCLUSIONS
ILD is a risk factor for operative mortality and morbidity after lung cancer resection, even in patients with normal pulmonary function.
背景
先前的研究表明，患有间质性肺疾病（ILD）的患者肺癌发病率增加，术后发生呼吸衰竭和死亡的风险增加。我们旨在了解ILD 对肺切除术全国范围内结局的影响。
方法
我们使用胸外科医师学会普通胸外科数据库，对 2009 年至 2019 年间接受非小细胞肺癌肺切除术的患者进行了回顾性队列分析。比较了有和无ILD（根据临床、影像学或病理学证据定义为间质纤维化）患者的基线特征和术后结局。多变量逻辑回归模型确定了与术后死亡率、急性呼吸窘迫综合征以及复合发病率和死亡率相关的危险因素。
结果
ILD 见于 128723 例接受非小细胞肺癌肺切除术患者中的 1.5%（1873 例）。ILD 患者更有可能吸烟（90%比 85%，P<0.001）、患有肺动脉高压（6%比 1.7%，P<0.001）、肺一氧化碳弥散量受损（肺一氧化碳弥散量 40%-75%：64%比 51%；肺一氧化碳弥散量<40%：11%比 4%，P<0.001），并且比无ILD 患者更多地接受亚肺叶切除术（34%比 23%，P<0.001）。ILD 患者术后死亡率（5.1%比 1.2%，P<0.001）、急性呼吸窘迫综合征（1.9%比 0.5%，P<0.001）和复合发病率和死亡率（13.2%比 7.4%，P<0.001）均升高。即使在调整了患者合并症、肺功能、切除范围和中心容量效应后，ILD 仍然是死亡率的一个强有力的预测因素（比值比，3.94；95%置信区间，3.09-5.01；P<0.001）。
结论
ILD 是肺癌切除术后手术死亡率和发病率的危险因素，即使在肺功能正常的患者中也是如此。
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