title: Post-operative acute exacerbation of pulmonary fibrosis in lung cancer patients undergoing lung resection.
abstract: Acute exacerbation (AE) of idiopathic pulmonary fibrosis (IPF) in lung cancer patients is a critical factor in post-operative mortality. The cause of AE development is unknown and AE may occur in patients without the diagnosis of IPF. We have conducted a retrospective study of consecutive patients who underwent lung cancer surgery since January 2004. Sixty-two patients with fibrous findings in preoperative high-resolution computed tomography were enrolled in the present study and clinicopathological factors were analysed. AE was observed in 6 of 62 patients. The frequency of AE according to the type of fibrous changes classification was 1/7 in the usual interstitial pneumonia (UIP) pattern, 1/16 in the cellular non-specific interstitial pneumonia (NSIP) pattern, 4/25 in the fibrotic NSIP pattern and 0/14 in the unclassified or focal fibrous changes pattern. Preoperative Krebs von den Lungen-6 (KL-6) was higher in patients with AE than in those without AE. In patients who underwent partial resection, AE did not develop even with high KL-6 levels. In conclusion, in patients with both the UIP and the NSIP patterns, AE development is possible. In patients with a high risk of AE, such as those with high KL-6 values, limited surgery may be an option to prevent AE development.
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. motoki@med.nagoya-cu.ac.jp
authors.forename: Motoki
authors.initials: M
authors.lastname: Yano
authors.forename: Hidefumi
authors.initials: H
authors.lastname: Sasaki
authors.forename: Satoru
authors.initials: S
authors.lastname: Moriyama
authors.forename: Yu
authors.initials: Y
authors.lastname: Hikosaka
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yokota
authors.forename: Susumu
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Hara
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fujii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D007564:Japan; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D018396:Mucin-1 / Q000032:analysis; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; C060192:MUC1 protein, human; D018396:Mucin-1