Department of Thoracic and Endocrine Surgery and Oncology, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
Int J Clin Oncol. 2024 Oct;29(10):1475-1482. doi: 10.1007/s10147-024-02600-5. Epub 2024 Aug 24.
The postoperative prognosis of patients with interstitial lung disease (ILD) and lung cancer is poor. Recently, the ILD-gender-age-physiology (GAP) index was identified as a clinical prognostic factor for patients with ILD. This study investigated the ILD-GAP index and oncological factors regarding postoperative outcomes.
We retrospectively reviewed 87 lung cancer patients with comorbid ILD who underwent curative resection at our institution between April 2005 and December 2019. Short-term postoperative outcomes and overall survival (OS) based on the ILD-GAP index were examined. OS rates after surgery were calculated using the Kaplan-Meier method, and group differences were analyzed using the Log-Rank test. Univariate and multivariate analyses for OS were performed using the Cox regression model.
Multivariate analyses revealed ILD-GAP index ≥ 4 [Hazard ratio, 3.349; 95% confidence interval 1.375-8.155; P = 0.008] as a factor associated with OS. In the ILD-GAP index ≥ 4 group, no deaths occurred from primary lung cancer, with respiratory-related deaths being the most common, and exacerbation of ILD was more frequent (P = 0.007). Regarding perioperative results, a significant difference was observed in 90-day mortality (2.7% vs. 23.0% [P = 0.022]), and more patients required home oxygen therapy (14.9% vs. 69.2% [P < 0.001]) in the ILD-GAP index ≥ 4 group.
An ILD-GAP index ≥ 4 indicated a poor prognostic factor for patients with surgically treated lung cancer. Careful consideration of surgical indications is essential for patients with an ILD-GAP index ≥ 4.
患有间质性肺病（ILD）和肺癌的患者的术后预后较差。最近，ILD-性别-年龄-生理学（GAP）指数被确定为ILD 患者的临床预后因素。本研究探讨了 ILD-GAP 指数和肿瘤学因素对术后结果的影响。
我们回顾性分析了 2005 年 4 月至 2019 年 12 月期间在我院接受治疗性切除的 87 例合并 ILD 的肺癌患者。根据 ILD-GAP 指数检查了短期术后结果和总体生存（OS）。使用 Kaplan-Meier 方法计算手术后的 OS 率，并使用对数秩检验分析组间差异。使用 Cox 回归模型对 OS 进行单因素和多因素分析。
多因素分析显示，ILD-GAP 指数≥4[风险比，3.349；95%置信区间 1.375-8.155；P=0.008]是与 OS 相关的因素。在 ILD-GAP 指数≥4 组中，无原发性肺癌死亡，以与呼吸相关的死亡最常见，ILD 恶化更为常见（P=0.007）。关于围手术期结果，ILD-GAP 指数≥4 组的 90 天死亡率有显著差异（2.7%比 23.0%[P=0.022]），需要家庭氧疗的患者更多（14.9%比 69.2%[P<0.001]）。
ILD-GAP 指数≥4 表明接受手术治疗的肺癌患者预后不良。对于 ILD-GAP 指数≥4 的患者，需要仔细考虑手术适应证。
