Abstract
Objective. 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. Methods. 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 (FEV1.0)/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. Results. Preoperative %FVC and %FEV1.0 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. Conclusion. Combined pulmonary fibrosis is a risk factor for patients with COPD after surgical treatment for lung cancer.
