title: Experience with perioperative pirfenidone for lung cancer surgery in patients with idiopathic pulmonary fibrosis.
abstract: OBJECTIVE
  Idiopathic pulmonary fibrosis (IPF) is a progressive diffuse lung disease associated with an increased risk of lung cancer. Patients with IPF sometimes develop a life-threatening acute exacerbation of IPF (AE-IPF) after lung cancer surgery. In this retrospective study, pirfenidone, an antifibrotic agent, was perioperatively administered to IPF patients with lung cancer with the aim of preventing postoperative AE-IPF, and the feasibility and clinical outcomes were investigated.
  
  
  METHODS
  Twelve IPF patients with concomitant lung cancer who received perioperative pirfenidone treatment (PPT) for lung cancer surgery were retrospectively investigated. Sixteen IPF patients undergoing lung cancer surgery without PPT were analyzed as historical controls.
  
  
  RESULTS
  Compared to the controls, the PPT patients had a more severely impaired preoperative pulmonary function and a larger number of limited pulmonary resections. There was a significant preoperative decrease in the serum KL-6 levels of the PPT patients. No severe pirfenidone-related complications or IPF-related events occurred in the PPT patients, while six control patients developed AE-IPF (P = 0.0167). A quantitative histopathological evaluation of resected lung specimens found that tissue changes associated with IPF were significantly fewer in the PPT patients (P = 0.021).
  
  
  CONCLUSIONS
  PPT is a feasible perioperative treatment for IPF patients with lung cancer. Its effectiveness in preventing postoperative AE-IPF thus warrants prospective verification.
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan. takeiwata-ths@umin.ac.jp.
authors.forename: Takekazu
authors.initials: T
authors.lastname: Iwata
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan. s-yoshida@faculty.chiba-u.jp.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Yoshida
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Nagato
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Nakajima
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Hidemi
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Tetsuzo
authors.initials: T
authors.lastname: Tagawa
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Teruaki
authors.initials: T
authors.lastname: Mizobuchi
authors.affiliation: Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ota
authors.affiliation: Department of Diagnostic Pathology, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Nakatani
authors.affiliation: Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuo-ku, Chiba, Chiba, 260-8670, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Yoshino
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000933:Antifibrinolytic Agents / Q000008:administration & dosage*; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000150:complications / Q000517:prevention & control* / Q000601:surgery*; D008175:Lung Neoplasms / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011728:Pyridones / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000933:Antifibrinolytic Agents; D011728:Pyridones; C093844:pirfenidone
keywords: Acute exacerbation; Idiopathic pulmonary fibrosis; Lung cancer; Pirfenidone; Surgery