Respiratory investigation · 2025
Incidence and risk factors of unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis after lung cancer surgery in interstitial lung disease patients.
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Nishimura Masashi, Sekine Akimasa, Inafuku Kenji, Moriuchi Asami, Tagami Yoichi, Ikeda Satoshi, Oda Tsuneyuki, Misumi Toshihiro, Arai Hiromasa, Baba Tomohisa, Komatsu Shigeru, Hagiwara Eri, Iwasawa Tae, Kaneko Takeshi, Ogura Takashi
Аннотация
BACKGROUND: Unilateral upper lung field pulmonary fibrosis (upper-PF) that is radiologically consistent with pleuroparenchymal fibroelastosis occasionally develops after lung cancer surgery in the operated side. However, the incidence and perioperative risk factors for unilateral upper-PF development remain unclear in lung cancer patients with interstitial lung disease (ILD).
METHODS: All consecutive lung cancer patients with ILD who underwent complete resection from 2008 to 2020 were investigated retrospectively. Pre-/postoperative characteristics were compared between patients with and without unilateral upper-PF. Cumulative incidence curves were estimated using competing risk analysis.
RESULTS: Among the 110 included patients, 20 patients (18.2 %) were diagnosed as developing unilateral upper-PF. The median interval from lung cancer surgery to unilateral upper-PF diagnosis was 16.5 months. The 3-, 5- and 10-year cumulative incidence was 15.5 %, 16.7 % and 20.1 %. In multivariable analysis, the presence of pulmonary apical cap and idiopathic pulmonary fibrosis (IPF) were independent perioperative risk factors. The 3-year cumulative incidence of unilateral upper-PF was 38.7 % in patients with pulmonary apical cap and 37.5 % in IPF patients. Pleural effusion at 6 months postoperatively was more frequent in patients who developed unilateral upper-PF later. During the clinical courses of 20 patients with unilateral upper-PF, 19 patients suffered from subsequent respiratory symptoms related to upper-PF and 14 patients died. Overall survival after unilateral upper-PF diagnosis was poor with a median of 33 months.
CONCLUSIONS: Thoracic surgeons and pulmonologists should recognize that unilateral upper-PF sometimes develops mostly within 3 years after lung cancer surgery as a poor prognostic late complication in ILD patients.
METHODS: All consecutive lung cancer patients with ILD who underwent complete resection from 2008 to 2020 were investigated retrospectively. Pre-/postoperative characteristics were compared between patients with and without unilateral upper-PF. Cumulative incidence curves were estimated using competing risk analysis.
RESULTS: Among the 110 included patients, 20 patients (18.2 %) were diagnosed as developing unilateral upper-PF. The median interval from lung cancer surgery to unilateral upper-PF diagnosis was 16.5 months. The 3-, 5- and 10-year cumulative incidence was 15.5 %, 16.7 % and 20.1 %. In multivariable analysis, the presence of pulmonary apical cap and idiopathic pulmonary fibrosis (IPF) were independent perioperative risk factors. The 3-year cumulative incidence of unilateral upper-PF was 38.7 % in patients with pulmonary apical cap and 37.5 % in IPF patients. Pleural effusion at 6 months postoperatively was more frequent in patients who developed unilateral upper-PF later. During the clinical courses of 20 patients with unilateral upper-PF, 19 patients suffered from subsequent respiratory symptoms related to upper-PF and 14 patients died. Overall survival after unilateral upper-PF diagnosis was poor with a median of 33 months.
CONCLUSIONS: Thoracic surgeons and pulmonologists should recognize that unilateral upper-PF sometimes develops mostly within 3 years after lung cancer surgery as a poor prognostic late complication in ILD patients.