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Clinical Outcomes and Prognosis of Patients With Interstitial Lung Disease Undergoing Lung Cancer Surgery: A Propensity Score Matching Study

  • Min Seo Ki
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Song Yee Kim
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Eun Young Kim
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Ji Ye Jung
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Young Ae Kang
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Moo Suk Park
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Young Sam Kim
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    # S.Y.P. and S.H.L contributed equally to this work.
    Seong Yong Park
    Correspondence
    Address for correspondence: Sang Hoon Lee, Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
    Footnotes
    # S.Y.P. and S.H.L contributed equally to this work.
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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  • Author Footnotes
    # S.Y.P. and S.H.L contributed equally to this work.
    Sang Hoon Lee
    Correspondence
    Address for correspondence: Sang Hoon Lee, Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
    Footnotes
    # S.Y.P. and S.H.L contributed equally to this work.
    Affiliations
    Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
    Search for articles by this author
  • Author Footnotes
    # S.Y.P. and S.H.L contributed equally to this work.
Published:October 13, 2022DOI:https://doi.org/10.1016/j.cllc.2022.10.003

      Abstract

      Background

      Patients with interstitial lung disease (ILD) may have a poor prognosis after lung cancer surgery because of respiratory complications and increased recurrence rates due to limited resection. Few studies have investigated prognosis after surgery by matching clinical variables between patients with and without ILD.

      Patients and Methods

      Medical records of patients who underwent lung cancer surgery between January 2010 and August 2020 at a referral hospital in South Korea were reviewed. Patients with ILD were identified based on preoperative computed tomography findings. Through propensity score matching, the clinical outcomes and prognoses of patients with (ILD group) and without ILD (control group) were compared.

      Results

      Of 1629 patients, 113 (6.9%) patients with ILD were identified, of whom 104 patients were matched. Before matching, patients with ILD had higher mean age, proportion of men, and rates of sublobar resection and squamous cell carcinoma than those without ILD. After matching, there was no significant difference in postoperative mortality rates between the control and ILD groups. The 5-year survival rate was significantly lower in the ILD group (66%) than in the control group (78.8%; P= .007). The 5-year survival rate of the ILD-GAP (Gender, Age, Physiology) stage III group (12.6%) was significantly lower than that of the ILD-GAP stage I (73.5%) and II groups (72.6%; P< .0001). Multivariable Cox analysis demonstrated that idiopathic pulmonary fibrosis, higher clinical stage, and recurrence were independent prognostic factors for mortality.

      Conclusion

      Concomitant ILD negatively affects long-term prognosis after lung cancer surgery, and ILD subtype and physiological severity assessment help predict prognosis after surgery.

      Keywords

      Abbreviations:

      BMI (body mass index), CT (computed tomography), DLCO (carbon monoxide diffusing capacity), ECOG (Eastern Cooperative Oncology Group), FEV1 (forced expiratory volume in 1 s), FVC (forced vital capacity), IIP (idiopathic interstitial pneumonia, ILD-AE, interstitial lung disease acute exacerbation), ILD (interstitial lung disease), IPF (idiopathic pulmonary fibrosis), NSCLC (non-small cell lung cancer), PFT (pulmonary function test), PSM (propensity score matching), UIP (usual interstitial pneumonia)
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