title: Long-term results and predictors of survival after surgical resection of patients with lung cancer and interstitial lung diseases.
abstract: OBJECTIVE
  Patients with interstitial lung diseases have a poor prognosis and are at increased risk of developing lung cancer. We evaluated the survival and predictors of survival after surgical resection in lung cancers in patients with interstitial lung diseases.
  
  
  METHODS
  We retrospectively analyzed data from 1763 patients with non-small cell lung cancer with a clinical diagnosis of interstitial lung disease who underwent pulmonary resection between 2000 and 2009 at 61 Japanese institutions.
  
  
  RESULTS
  Male patients (90.4%) and smokers (93.8%) were in the majority. The overall 5-year survival was 40%. The 5-year survivals were 59%, 42%, 43%, 29%, 25%, 17%, and 16% for patients with stage Ia, Ib, IIa, IIb, IIIa, IIIb, and IV, respectively. Patients with stage IA had a 5-year survival of 33.2%, 61.0%, and 68.4% in the wedge resection, segmentectomy, and lobectomy groups, respectively (log-rank test, P = .0038). The leading cause of death was cancer recurrence (50.2%), followed by respiratory failure (26.8%). Wedge resection reduced mortality due to respiratory failure when compared with that of lobectomy (P = .022). Multivariable analysis revealed that the type of surgical procedure, predicted percent vital capacity, and tumor locations were independent predictors for survival. The 5-year survival was 20% for patients with stage Ia with a predicted percent vital capacity of 80% or less, and 64.3% for patients with a predicted percent vital capacity greater than 80% (log-rank test, P < .0001).
  
  
  CONCLUSIONS
  In these patients, there are competing risks of death. Wedge resection reduced death caused by respiratory failure but resulted in poorer long-term prognosis than lobectomy. For patients with poor predictors of survival, such as predicted percent vital capacity of 80% or less, surgical resection should be limited.
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Kyoto, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Sato
authors.affiliation: Department of Thoracic Surgery, Sapporo Medical University School of Medicine and Hospital, Sapporo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Watanabe
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 Surgery I, Tokyo Women's Medical University Hospital, Tokyo, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Kanzaki
authors.affiliation: Department of Thoracic Surgery, Tokyo Medical and Dental University, Tokyo, Japan.
authors.forename: Kenichi
authors.initials: K
authors.lastname: Okubo
authors.affiliation: Department of Thoracic Surgery, Nagoya University Hospital, Nagoya, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Yokoi
authors.affiliation: Kishiwada City Hospital, Kishiwada, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Matsumoto
authors.affiliation: Kumamoto Chuo Hospital, Kumamoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Marutsuka
authors.affiliation: Niigata University Graduate School of Medical and Dental Sciences of Thoracic and Cardiovascular Surgery, Niigata, Japan.
authors.forename: Hirohiko
authors.initials: H
authors.lastname: Shinohara
authors.affiliation: Innovative Clinical Research Center, Kanazawa University, Kanazawa, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.affiliation: Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Kishi
authors.affiliation: Respiratory Center, Tohoku Pharmaceutical University Hospital, Sendai, Japan.
authors.forename: Masahito
authors.initials: M
authors.lastname: Ebina
authors.affiliation: Department of Pulmonary Medicine, Jichi Medical University, Tochigi, Japan.
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Sugiyama
authors.affiliation: Department of General Thoracic Surgery, Oosaka Medical Center for Cancer and Cardiovascular Diseases, Oosaka, Japan.
authors.forename: Okumora
authors.initials: O
authors.lastname: Meinoshin
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 / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008168:Lung / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D017563:Lung Diseases, Interstitial / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D016017:Odds Ratio; D018579:Patient Selection; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014797:Vital Capacity