title: Severity of lung fibrosis affects early surgical outcomes of lung cancer among patients with combined pulmonary fibrosis and emphysema.
abstract: Combined pulmonary fibrosis and emphysema (CPFE) is defined as upper lobe emphysema and lower lobe fibrosis, which are representative lung disorders that increase the prevalence of lung cancer. This unique disorder may affect the morbidity and mortality during the early period after surgery. The present study aimed to identify which clinicopathological features significantly affect early surgical outcomes after lung resection in nonsmall cell lung cancer (NSCLC) patients and in those with CPFE.We retrospectively assessed 2295 patients with NSCLC and found that 151 (6.6%) had CPFE. All were surgically treated between January 2008 and December 2010 at 4 institutions.The postoperative complication rates for patients with and without CPFE were 39% and 17%, respectively. The 90-day mortality rates were higher among patients with than without CPFE (7.9% vs 1%). Acute exacerbation of interstitial pneumonia was the main cause of death among 12 patients with CPFE who died within 90 days after surgery. Multivariate logistic regression analysis selected CPFE, gender, age, and clinical stage as independent predictive factors for postoperative complications, and CPFE, clinical stage, and sex for 90-day mortality. The severity of lung fibrosis on preoperative CT images was an independent predictive factor for 90-day mortality among patients with CPFE.The key predictive factor for postoperative mortality and complications of lung resection for NSCLC was CPFE. The severity of lung fibrosis was the principal predictor of early outcomes after lung surgery among patients with CPFE and NSCLC.
authors.affiliation: Department of Surgical Oncology, Hiroshima University, Hiroshima Department of General Thoracic Surgery, Juntendo University School of Medicine, Tokyo Division of Thoracic Surgery, National Cancer Center Hospital East, Kashiwa Department of Surgery, Tokyo Medical University, Tokyo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Mimae
authors.forename: Kenji
authors.initials: K
authors.lastname: Suzuki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tsuboi
authors.forename: Norihiko
authors.initials: N
authors.lastname: Ikeda
authors.forename: Kazuya
authors.initials: K
authors.lastname: Takamochi
authors.forename: Keiju
authors.initials: K
authors.lastname: Aokage
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Shimada
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyata
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D011656:Pulmonary Emphysema / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D011658:Pulmonary Fibrosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D066066:Response Evaluation Criteria in Solid Tumors; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed