肺線維症と慢性閉塞性肺疾患の合併が肺癌手術成績に及ぼす影響  [in Japanese] The Impact of Combined Pulmonary Fibrosis and Chronic Obstructive Pulmonary Disease on Long-term Survival After Lung Cancer Surgery  [in Japanese]

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Author(s)

    • 関根 康雄 Sekine Yasuo
    • 東京女子医科大学八千代医療センター呼吸器外科|千葉大学大学院医学研究院呼吸器病態外科学 Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center|Department of Thoracic Surgery, Graduate School of Medicine, Chiba University
    • 坂入 祐一 Sakairi Yuichi
    • 千葉大学大学院医学研究院呼吸器病態外科学 Department of Thoracic Surgery, Graduate School of Medicine, Chiba University
    • 鈴木 秀海 Suzuki Hidemi
    • 千葉大学大学院医学研究院呼吸器病態外科学 Department of Thoracic Surgery, Graduate School of Medicine, Chiba University
    • 芳野 充 Yoshino Mitsuru
    • 東京女子医科大学八千代医療センター呼吸器外科 Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center
    • 黄 英哲 Koh Eitetsu
    • 東京女子医科大学八千代医療センター呼吸器外科 Department of Thoracic Surgery, Tokyo Women's Medical University Yachiyo Medical Center
    • 吉野 一郎 Yoshino Ichiro
    • 千葉大学大学院医学研究院呼吸器病態外科学 Department of Thoracic Surgery, Graduate School of Medicine, Chiba University

Abstract

<b>目的</b>.本研究の目的は,COPD合併肺癌患者における肺癌手術後合併症および長期予後に与える肺線維症の影響を調べることにある.<b>方法</b>.1990~2005年に千葉大学病院にて施行された肺癌手術症例のうちCOPD合併例380例を対象とした.慢性閉塞性肺疾患(COPD)および肺線維症(PF)の診断基準は,術前肺機能1秒率<70%,胸部CTで両側肺底区域の線維化とした.41例(10.8%)がPF/COPD群,339例(89.2%)がCOPD alone群であった.<b>結果</b>.術前肺機能検査では,%FVCおよび%FEV<sub>1.0</sub>はPF/COPD群で有意に低かった.術後合併症では,術後急性肺傷害(ALI)および在宅酸素療法(HOT)がPF/COPD群で有意に高かったが,30日死亡に有意差はなかった.3,5年生存率ではPF/COPD群で53.6%,36.9%に対し,COPD alone群で71.4%,66.1%と,COPD alone群で有意に良好であった(p=0.0009).肺癌の無再発生存率もCOPD alone群で有意に高かった.多変量解析の結果,男性,BMI,病理病期,PFが予後不良因子として挙がった.<b>結論</b>.PFはCOPD合併肺癌患者においてその予後をさらに低下させる危険因子であった.<br>

<i><b>Objective</b></i>. The purpose was to determine the impact of pulmonary fibrosis (PF) on postoperative complications and long-term survivals in lung cancer patients with chronic obstructive pulmonary disease (COPD) after surgical resection. <i><b>Methods</b></i>. A retrospective chart review of 380 patients with COPD who had undergone pulmonary resection for lung cancer at Chiba University Hospital between 1990 and 2005 was performed. Definitions of COPD and PF were preoperative forced expiratory volume in one second (FEV<sub>1.0</sub>)/force vital capacity (FVC) less than 70% and bilateral obvious fibrous change at lower lung field confirmed by computed tomography, respectively. The PF/COPD group consisted of 41 patients (10.8%) with COPD and PF, and the COPD alone group consisted of the remaining 339 patients (89.2%) with COPD but were without PF. <i><b>Results</b></i>. Preoperative %FVC and %FEV<sub>1.0</sub> were significantly lower in the PF/COPD group than in the COPD alone group (p<0.05). Acute lung injury (ALI) and home oxygen therapy (HOT) were significantly higher in the PF/COPD group. However, 30-day mortality was similar between the two groups. The cumulative survival at 3 and 5 years were 53.6% and 36.9% in the PF/COPD group and 71.4% and 66.1% in the COPD alone group, respectively (p=0.0009). The COPD alone group had a significantly better survival rate than the PF/COPD group due to less cancer recurrence. Using multiple logistic regression analysis, we identified the following as independent risk factors: male gender, decreased BMI, advanced pathologic stage, and existence of pulmonary fibrosis. <i><b>Conclusion</b></i>. Combined pulmonary fibrosis is a risk factor for patients with COPD after surgical treatment for lung cancer.<br>

Journal

  • Haigan

    Haigan 53(1), 7-11, 2013

    The Japan Lung Cancer Society

Codes

  • NII Article ID (NAID)
    130003366327
  • Text Lang
    JPN
  • ISSN
    0386-9628
  • Data Source
    J-STAGE 
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