P1.16-25 Impact of Pirfenidone on the Risk Scoring System of Postoperative Acute Exacerbation of Interstitial Pneumonia in Lung Cancer

Abstract

Acute exacerbation (AE) of idiopathic interstitial pneumonia (IIP) is a life-threatening complication of lung cancer resection. There has been an increasing number of studies about postoperative AE of IIP in recent years. A few of these have reported that perioperative oral administration of pirfenidone reduces the occurrence of AE in patients with IIP. Furthermore, a large cohort study conducted by the Japanese Association for Chest Surgeons (JACS) proposed risk factors for postoperative AE in IIP patients which can predict the incidence of AE following an operation. JACS risk score included seven factors (sex, history of AE, surgical procedure, usual interstitial pneumonia pattern, steroid use, KL-6, %VC) and classified patients into three groups: low risk (risk score: 0-10), intermediate risk (risk score: 11-14) and high risk (risk score: 15-22). The objective of present study is to investigate the validity of those risk factors for patients with IIP who are taking pirfenidone. We retrospectively analyzed 1626 consecutive lung cancer patients who had undergone lung resection at our institution from January 2010 to December 2018. The patients who underwent lung resection since 2016 onward were administered pirfenidone from 4 weeks before operation to 4 weeks after operation. Out of 1626 patients, 125 patients (7.7%) had IIP. Twenty patients (16%) took pirfenidone and 105 patients (84%) did not take pirfenidone. Of the patients taking pirfenidone, three patients (15%) contracted AE of IIP after lung resection within 30 postoperative days. No significant difference was identified in JACS risk score between AE (+) group taking pirfenidone and AE (-) group taking pirfenidone (10.7 ± 3.2 versus 8.6 ± 2.6, p = 0.74). In the AE (+) group taking pirfenidone, there were significant higher rates of patients having increased serum levels of KL-6 or having reached pathological stage II-IV (UICC 8th) (p = 0.01 , p = 0.04, respectively). Of the patients not taking pirfenidone, seven patients (6.7%) contracted AE of IIP. No significant difference was identified in incidence of postoperative AE between the group of patients taking pirfenidone and the group not taking pirfenidone (p = 0.21). In the patients taking pirfenidone, there was no significant difference in the risk score between AE (+) group and AE (-) group.