Abstract
BackgroundThere is only limited information on the impact of thin-section computed tomography (TSCT)-determined usual interstitial pneumonia (UIP) pattern in the decision-making for resection in newly diagnosed lung cancer patients.MethodsIn this retrospective analysis, data were reviewed from 499 newly diagnosed lung cancer patients who received bronchoscopy between 2010 and 2014. The clinical impact of TSCT-determined UIP pattern on the decision-making process for resection in this cohort was evaluated.ResultsThe prevalence rate of TSCT-determined fibrosis was 14.8% (74/499 cases), 86.5% (64/74 cases) of which also had TSCT-determined emphysema. The fibrosis group comprised 40 patients with possible UIP and 34 patients with the UIP pattern. Among surgical candidates, the number of surgeries performed was lower in the fibrosis group (60.8%) than in the normal and emphysema groups (84.7 and 77.3%, respectively). Although the proportion of possible UIP did not differ between surgical candidates and patients with resected lung cancer, the proportion of UIP pattern in patients with resected lung cancer was decreased by 8.5%, compared to the surgical candidates. Although measurement of diffusing capacity of the lung for carbon monoxide (DLCO) was performed in more than 97% of patients with thoracic surgery, only 58% of patients without thoracic surgery had DLCO measurement. Multivariate analysis showed that the finding of UIP pattern independently affects the decision-making process for thoracic surgery. The adjusted odds ratios for the comparison between the patients without fibrosis and the patients with UIP pattern was 0.266 (95% confidence intervals: 0.087–0.812).ConclusionsThe presence of TSCT-determined UIP pattern might independently affect the decision-making process for proposing thoracic surgery with curative intent.
Highlights
There is only limited information on the impact of thin-section computed tomography (TSCT)-determined usual interstitial pneumonia (UIP) pattern in the decision-making for resection in newly diagnosed lung cancer patients
We recently demonstrated that the presence of TSCT-determined combined pulmonary fibrosis and emphysema (CPFE) yielded worse postoperative and survival outcomes in patients with resected lung cancer, less than 30% of patients with fibrosis had TSCT-determined UIP pattern among resected lung cancer cases [14]
New therapeutic options for stable chronic lung diseases such as COPD/emphysema and pulmonary fibrosis have been utilized in the worldwide [15, 16]
Summary
There is only limited information on the impact of thin-section computed tomography (TSCT)-determined usual interstitial pneumonia (UIP) pattern in the decision-making for resection in newly diagnosed lung cancer patients. There is increasing awareness that the presence of emphysema or fibrosis clinically affects postoperative and survival outcomes for patients with resected lung cancer [8,9,10,11]. We hypothesized that TSCT-determined UIP pattern might affect the decision-making process for resection in newly diagnosed lung cancer patients. To establish appropriate therapeutic strategy for chronic lung diseases among newly diagnosed lung cancer patients, clinical impact of TSCTdetermined UIP pattern on the decision-making process for proposing thoracic surgery should be determined. Bronchoscopy is performed for most lung cancer patients before the lung cancer treatment decision is made [17, 18]
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