Ishibashi Hironori, Hanafusa Mariko, Asakawa Ayaka, Ishikawa Yuya, Wakejima Ryo, Horibe Shota, Okubo Kenichi
Department of Thoracic Surgery, Graduate School of Medical and Dental Sciences, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
Division of Cohort Research, National Cancer Center Institute for Cancer Control, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun 6. doi: 10.1007/s11748-025-02164-9.
Unilateral upper lung field pulmonary fibrosis (UPF) is a possible complication on the operated side after lung cancer surgery. However, its incidence and associated perioperative factors remain unclear. This study investigated the clinical characteristics of patients with unilateral UPF after primary lung cancer surgery.
We reviewed the records of all consecutive patients with lung cancer who underwent complete resection at the Institute of Science, Tokyo, between July 2010 and December 2021. We estimated the cumulative incidence and sub-hazard ratios using competing risk regression models.
A total of 979 patients were included in this analysis. The median follow-up period up to the last follow-up was 59.2 months (interquartile range 37.0-84.6 months). With 39 (4.0%) cases of postoperative unilateral UPF, the median follow-up time until the diagnosis of unilateral UPF was 25.5 months (interquartile range 12.9-45.3 months), and the 3-, 5-, and 10-year cumulative incidences of unilateral UPF were 2.7%, 4.0%, and 5.4%, respectively. The 5-year overall survival rate was 87.3%; however, 30 of the 39 patients (76.9%) with unilateral UPF experienced subsequent complications related to unilateral UPF, such as progressive respiratory distress, progressive body weight loss, and pneumonia. Age > 75 years, male sex, low body mass index (< 20 kg/m), ischemic heart disease, history of pneumonia, emphysema, pulmonary apical cap, and right lower lobe tumors are possible risk factors for unilateral UPF.
Unilateral UPF is an unrecognized late complication of lung cancer surgery that should be carefully monitored in patients with risk factors.
单侧上肺野肺纤维化（UPF）是肺癌手术后手术侧可能出现的并发症。然而，其发病率及相关围手术期因素仍不清楚。本研究调查了原发性肺癌手术后单侧UPF患者的临床特征。
我们回顾了2010年7月至2021年12月期间在东京科学研究所接受根治性切除的所有连续性肺癌患者的记录。我们使用竞争风险回归模型估计累积发病率和亚风险比。
本分析共纳入979例患者。截至最后一次随访的中位随访期为59.2个月（四分位间距37.0 - 84.6个月）。39例（4.0%）术后出现单侧UPF，诊断单侧UPF的中位随访时间为25.5个月（四分位间距12.9 - 45.3个月），单侧UPF的3年、5年和10年累积发病率分别为2.7%、4.0%和5.4%。5年总生存率为87.3%；然而，39例单侧UPF患者中有30例（76.9%）随后出现与单侧UPF相关的并发症，如进行性呼吸窘迫、进行性体重减轻和肺炎。年龄>75岁、男性、低体重指数（<20 kg/m²）、缺血性心脏病、肺炎病史、肺气肿、肺尖帽和右下叶肿瘤可能是单侧UPF的危险因素。
单侧UPF是肺癌手术一种未被认识的晚期并发症，对于有危险因素的患者应仔细监测。
