Fukui Mariko, Matsunaga Takeshi, Hattori Aritoshi, Takamochi Kazuya, Tomita Hisashi, Nojiri Shuko, Suzuki Kenji
Department of General Thoracic Surgery, Juntendo University School of Medicine, 1-3, Hongo 3-chome, Bunkyo-ku, Tokyo, 113-8431, Japan.
Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2024 Oct 23. doi: 10.1007/s11748-024-02096-w.
Post-surgical survival outcomes in patients with non-small-cell lung cancer (NSCLC) and idiopathic pulmonary fibrosis (IPF) are expected to be worse than those in patients with other idiopathic interstitial pneumonias (IIPs). However, these remain unclear regarding patients with NSCLC and IPF histologically diagnosed as usual interstitial pneumonia [IPF(UIP)]. We aimed to assess the surgical and survival outcomes and identify prognostic factors in patients with NSCLC and IPF(UIP).
This retrospective cohort study included patients with pathological stage I-III NSCLC and UIP. Prognostic factors and their association with lung cancer deaths (LCDs) and non-LCDs (NLCDs) were investigated.
The overall survival of patients with UIP was significantly poorer than that of others with IIPs. The main causes of death were lung cancer (36%) and respiratory disease (44%). Multivariate analyses revealed the pathological stage of NSCLC ≥ II (hazard ratio [HR], 2.196; p = 0.009) and GAP stage ≥ II (HR, 2.821; p = 0.016) to be significant prognostic factors. NLCD incidence was significantly high in patients with GAP stage ≥ II. Recurrence occurred in 26 patients (36.1%); the period from recurrence to death was shorter in patients with IPF(UIP) than in patients without IPF(UIP).
Patients with NSCLC and IPF(UIP) had poor prognosis after surgery. However, the prognosis varied greatly depending on the GAP stage. Considering the difficulty in managing post-surgical recurrence and high incidence of LCDs in patients with IPF(UIP), pursuing a radical resection is recommended in patients with GAP stage I. For patients with GAP stage ≥ II, comprehensive management of UIP is also necessary.
非小细胞肺癌（NSCLC）合并特发性肺纤维化（IPF）患者的术后生存结局预计比其他特发性间质性肺炎（IIP）患者更差。然而，对于组织学诊断为普通间质性肺炎[IPF（UIP）]的NSCLC合并IPF患者，这些情况仍不明确。我们旨在评估NSCLC合并IPF（UIP）患者的手术及生存结局，并确定预后因素。
这项回顾性队列研究纳入了病理分期为I - III期的NSCLC和UIP患者。研究了预后因素及其与肺癌死亡（LCD）和非肺癌死亡（NLCD）的关联。
UIP患者的总生存期明显低于其他IIP患者。主要死亡原因是肺癌（36%）和呼吸系统疾病（44%）。多因素分析显示，NSCLC病理分期≥II期（风险比[HR]，2.196；p = 0.009）和GAP分期≥II期（HR，2.821；p = 0.016）是显著的预后因素。GAP分期≥II期的患者NLCD发生率显著较高。26例患者（36.1%）出现复发；IPF（UIP）患者从复发到死亡的时间比无IPF（UIP）的患者短。
NSCLC合并IPF（UIP）患者术后预后较差。然而，预后因GAP分期不同而有很大差异。考虑到IPF（UIP）患者术后复发管理困难且LCD发生率高，建议GAP I期患者进行根治性切除。对于GAP分期≥II期的患者，UIP的综合管理也很有必要。
