Chronic pulmonary aspergillosis as a sequel to lobectomy for lung cancer.
OBJECTIVE
Chronic pulmonary aspergillosis (CPA) is an emerging complication after lobectomy for lung cancer. This retrospective study aimed to determine the incidence, main risk factors and clinical features of postoperative CPA in lung cancer patients.


METHODS
This study included lung cancer patients treated by lobectomy and with no previous history of thoracic surgery or coexistent aspergillosis at the time of surgery. The cumulative incidence of CPA was determined using death as a competing risk. Furthermore, the identified lung cancer patients were divided into CPA and non-CPA groups to compare their preoperative clinical features and to identify the risk factors of postoperative CPA by univariable and multivariable analyses. We also analysed the clinical features of CPA patients after diagnosis.


RESULTS
We included 475 lung cancer patients. Of these, 17 patients (3.6%) developed CPA after the lobectomy. The cumulative postoperative incidence rate of CPA was 2.3% [95% confidence interval (CI), 0.8-3.8%] at 5 years and 7.9% (95% CI, 3.0-13.0%) at 10 years. There were significantly more men (P = 0.007), smokers (P = 0.002) and comorbid chronic obstructive pulmonary disease (COPD) (P = 0.008) and interstitial lung disease (ILD) (P = 0.009) patients in the CPA group than in the non-CPA group. Multivariable analysis identified comorbid COPD (P = 0.0019) and ILD (P = 0.0003) as significant risk factors. An antifungal treatment response was obtained in 6 patients (35%). The 1-year survival rate was 47% (follow-up periods, interquartile range: 3-78 months), and 5 of the total of 11 deaths were due to CPA.


CONCLUSIONS
Through the present retrospective study, CPA seems to be a common sequel to lobectomy in lung cancer patients, and COPD and ILD represent strong risk factors of postoperative CPA. Because of the poor clinical outcome of lung cancer patients who develop CPA after lobectomy, careful follow-up using several examinations and chest radiographs to make CPA diagnosis may be essential.
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan Clinical Research Center, Pathology and Epidemiology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan tamura-in@tokyo-hosp.jp.
Atsuhisa
A
Tamura
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Junko
J
Suzuki
Center for Pulmonary Diseases and Chest Surgery Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Takeshi
T
Fukami
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Hirotoshi
H
Matsui
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Shinobu
S
Akagawa
Center for Pulmonary Diseases and Respiratory Disease Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Ken
K
Ohta
Clinical Research Center, Pathology and Epidemiology Division, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Akira
A
Hebisawa
Clinical Research, Innovation and Education Center, Tohoku University Hospital, Miyagi, Japan.
Fumiaki
F
Takahashi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008175:Lung Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000009:adverse effects*; D011184:Postoperative Period; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed; D055815:Young Adult
Chronic obstructive pulmonary disease; Chronic pulmonary aspergillosis; Interstitial lung disease; Lobectomy; Lung cancer; Sequel