Background

The incidence of acute exacerbation (AE) 31 days after surgery in lung cancer (LC) patients with interstitial lung disease (ILD) has not yet been elucidated. This study aimed to identify the AE incidence rate, mortality rate, and risk factors in patients with late-stage LC with ILD.

Methods

We conducted a retrospective study on 410 patients with ILD on preoperative computed tomography among 3939 patients with LC who underwent their first surgery between August 2008 and July 2019. We divided the patients into Group A (early AE; 18cases), Group B (late AE; 40 cases), and Group C (no AE; 352 cases).

Results

There were no significant differences in the clinical background between Groups A and B. The AE incidence rates were 0.56 case per person-years at ≤ 30 days, 0.24 at 90 days, 0.14 at 180 days, 0.10 at 1 year, 0.078 at 2 years, 0.086 at 3 years, 0.064 at 4 years, and 0.059 at 5 years after surgery. The mortality rates of the first AE were 10/18 (56%), 3/5 (60%), 7/13 (54%), and 7/22 (32%) at onset ≤ 30 days, 31–90 days, 91–365 days, and 366–1825 days after surgery, respectively. Multivariate Cox proportional analysis showed that adjuvant chemotherapy and a usual IP (UIP) pattern on CT + KL-6 ≥ 1000 (hazard ratio 3.647, 2.631) were predictors of late AEs.

Conclusions

Patients with adjuvant chemotherapy and a usual IP (UIP) pattern on CT + KL-6 ≥ 1000 are likely to develop later AEs. Therefore, early intervention with antifibrotic therapy is recommended.

中文翻译：

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是否可以预测间质性肺疾病术后晚期发生的急性加重？

背景

肺癌 (LC) 合并间质性肺病 (ILD) 患者术后 31 天急性加重 (AE) 的发生率尚未阐明。本研究旨在确定晚期 LC 伴 ILD 患者的 AE 发生率、死亡率和危险因素。

方法

我们对 2008 年 8 月至 2019 年 7 月期间接受首次手术的 3939 例 LC 患者中的 410 例 ILD 患者进行术前计算机断层扫描的回顾性研究。我们将患者分为 A 组（早期 AE；18 例）、B 组（晚期 AE ；40 例）和 C 组（无 AE；352 例）。

结果

A组和B组之间的临床背景无显着差异。AE发生率分别为≤30天时每人年0.56例、90天时0.24例、180天时0.14例、1年时0.10例、2年时0.078例，术后 3 年为 0.086，4 年为 0.064，术后 5 年为 0.059。首发 AE 的死亡率分别为 10/18 (56%)、3/5 (60%)、7/13 (54%) 和 7/22 (32%)，发病 ≤ 30 天、31-90 天，分别在术后 91-365 天和 366-1825 天。多变量 Cox 比例分析显示，辅助化疗和 CT + KL-6 ≥ 1000 的常规 IP (UIP) 模式（风险比 3.647, 2.631）是晚期 AE 的预测因子。

结论

接受辅助化疗且 CT + KL-6 ≥ 1000 为常规 IP (UIP) 模式的患者可能会出现后期 AE。因此，建议早期干预抗纤维化治疗。