Iida Takahiro, Sato Masaaki, Fukami Takeshi
Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan.
J Thorac Dis. 2024 Aug 31;16(8):5097-5109. doi: 10.21037/jtd-24-452. Epub 2024 Aug 28.
"Progressive destroyed lung (PDL)" refers to a state in which the normal structure and function of the lung are permanently disrupted owing to repeated inflammation. After lung cancer surgery, the remaining lung tissue can experience progressive destruction; however, the exact cause remains unclear. In this study, we retrospectively analyzed cases in which the remaining lung deteriorated after lung cancer surgery and investigated the associated risk factors.
A case-control study was conducted on 31 cases of PDL and 247 cases of non-PDL among 1,234 patients who underwent surgery for primary lung cancer from 2006 to 2021. The following factors were analyzed: age, sex, medical history, smoking status, surgical procedure, lung cancer histology, surgical approach, postoperative complications, chemotherapy, radiation therapy, and lung cancer recurrence. Patients were matched 1:1 based on preoperative factors, and postoperative risk factors were evaluated using multivariate logistic regression analysis.
A higher proportion of men and higher prevalence of chronic lung diseases, smokers, squamous cell carcinoma (SCC), postoperative acute pneumonia, chronic pneumonia, air leak, and history of radiation therapy were noted in the PDL group than in the non-PDL group. In the analysis following propensity score matching, chronic pneumonia [odds ratio (OR): 10.1, 95% confidence interval (CI): 2.9 to 35.8] was identified as an independent risk factor for PDL.
In this study, PDL after lung cancer surgery was associated with postoperative chronic pneumonia, including infection and aspiration pneumonia.
“进行性毁损肺（PDL）”是指由于反复炎症导致肺的正常结构和功能永久受损的一种状态。肺癌手术后，剩余肺组织可能会出现进行性毁损，但其确切原因尚不清楚。在本研究中，我们回顾性分析了肺癌手术后剩余肺组织恶化的病例，并调查了相关危险因素。
对2006年至2021年接受原发性肺癌手术的1234例患者中的31例PDL患者和247例非PDL患者进行了病例对照研究。分析了以下因素：年龄、性别、病史、吸烟状况、手术方式、肺癌组织学类型、手术入路、术后并发症、化疗、放疗以及肺癌复发情况。根据术前因素将患者进行1:1匹配，并使用多因素逻辑回归分析评估术后危险因素。
与非PDL组相比，PDL组男性比例更高，慢性肺部疾病、吸烟者、鳞状细胞癌（SCC）、术后急性肺炎、慢性肺炎、漏气以及放疗史的患病率更高。在倾向得分匹配后的分析中，慢性肺炎[比值比（OR）：10.1，95%置信区间（CI）：2.9至35.8]被确定为PDL的独立危险因素。
在本研究中，肺癌手术后的PDL与术后慢性肺炎有关，包括感染和吸入性肺炎。
