Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine.
Department of Cardiovascular and Thoracic Surgery, Ehime University Graduate School of Medicine.
Acta Med Okayama. 2023 Jun;77(3):301-309. doi: 10.18926/AMO/65495.
Acute exacerbation (AE) of interstitial lung disease (ILD) is a severe complication of lung resection in lung cancer patients with ILD (LC-ILD). This study aimed to assess the predictive value of comorbidities other than ILD for postoperative AE in patients with LC-ILD. We retrospectively evaluated 68 patients with LC-ILD who had undergone lung resection. We classified them into two groups: those who had developed postoperative AE within 30 days after resection and those who had not. We analyzed patient characteristics, high-resolution computed tomography findings, clinical data, pulmonary function, and intraoperative data. The incidence of postoperative AEs was 11.8%. In univariate analysis, performance status (PS), honeycombing, forced vital capacity (FVC), and high hemoglobin A1c (HbA1c) levels without comorbidities were significantly associated with postoperative AE. Patients were divided into two groups according to cutoff levels of those four variables as determined by receiver operating characteristic curves, revealing that the rates of patients without postoperative AE differed significantly between groups. The present results suggested that preoperative comorbidities other than ILD were not risk factors for postoperative AE in patients with LC-ILD. However, a high preoperative HbA1c level, poor PS, low FVC, and honeycombing may be associated with postoperative AE of LC-ILD.
特发性肺纤维化急性加重是肺癌合并间质性肺疾病（ILD）患者肺切除术后的严重并发症。本研究旨在评估除ILD 以外的合并症对肺癌合并ILD 患者术后急性加重的预测价值。我们回顾性评估了 68 例接受肺切除术的肺癌合并ILD 患者。我们将他们分为两组：术后 30 天内发生术后急性加重的患者和未发生的患者。我们分析了患者特征、高分辨率计算机断层扫描结果、临床数据、肺功能和术中数据。术后急性加重的发生率为 11.8%。在单因素分析中，表现状态（PS）、蜂窝肺、用力肺活量（FVC）和无合并症的高糖化血红蛋白 A1c（HbA1c）水平与术后急性加重显著相关。根据受试者工作特征曲线确定的这四个变量的截断值，将患者分为两组，结果显示两组术后无急性加重的患者比例差异显著。本研究结果提示，除ILD 以外的术前合并症不是肺癌合并ILD 患者术后急性加重的危险因素。然而，术前高 HbA1c 水平、较差的 PS、低 FVC 和蜂窝肺可能与肺癌合并ILD 的术后急性加重有关。
