title: Impact and predictors of acute exacerbation of interstitial lung diseases after pulmonary resection for lung cancer.
abstract: OBJECTIVE
  The study objective was to examine the incidence, risk factors, and mortality rate of acute exacerbation of interstitial lung diseases in patients with lung cancer undergoing pulmonary resection in a large-scale multi-institutional cohort.
  
  
  METHODS
  We retrospectively analyzed 1763 patients with non-small cell lung cancer who had undergone pulmonary resection and presented with a clinical diagnosis of interstitial lung diseases between January 2000 and December 2009 at 61 hospitals in Japan. The incidence and outcomes of acute exacerbation within 30 days from the operation were investigated. Univariate and multivariate logistic regression analyses were used to identify independent risk factors of acute exacerbation.
  
  
  RESULTS
  Acute exacerbation occurred in 164 patients (9.3%; 95% confidence interval, 8.0-10.8), with a mortality rate of 43.9%, and was the top cause of 30-day mortality (71.7%). The following 7 independent risk factors of acute exacerbation were identified: surgical procedures, male sex, history of exacerbation, preoperative steroid use, serum sialylated carbohydrate antigen KL-6 levels, usual interstitial pneumonia appearance on computed tomography scan, and reduced percent predicted vital capacity. Surgical procedures showed the strongest association with acute exacerbation (using wedge resection as the reference, lobectomy or segmentectomy: odds ratio, 3.83; 95% confidence interval, 1.94-7.57; bi-lobectomy or pneumonectomy: odds ratio, 5.70; 95% confidence interval, 2.38-13.7; P < .001). The effect of perioperative prophylactics, such as steroids and sivelestat, was not confirmed in this study.
  
  
  CONCLUSIONS
  Pulmonary resection for patients with lung cancer with interstitial lung diseases may provoke acute exacerbation at a substantially high rate and has high associated mortality. Surgical procedures that proved to be a risk factor for acute exacerbation should be chosen cautiously for these high-risk patients.
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.affiliation: Department of Thoracic Surgery, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kondo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
authors.affiliation: Department of Respirology, Tohoku University, Sendai, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Ebina
authors.affiliation: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kishi
authors.affiliation: Department of Oncology, Immunology and Surgery, Nagoya City University, Nagoya, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Fujii
authors.affiliation: Department of Thoracic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan (presently at the Department of Thoracic Surgery, Kinki University Faculty of Medicine, Osaka, Japan).
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsudomi
authors.affiliation: Department of Thoracic Surgery, Hyogo Cancer Center, Akashi, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshimura
authors.affiliation: Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Maniwa
authors.affiliation: Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Thoracic Surgery, Hiroshima City Hospital, Hiroshima, Japan (presently at the Department of Thoracic Surgery, Iwakuni Clinical Center, Yamaguchi, Japan).
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kataoka
authors.affiliation: Department of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
authors.affiliation: Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kondo
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan. Electronic address: hdate@kuhp.kyoto-u.ac.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Date
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011013:Pneumonectomy / Q000009:adverse effects* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome