Predicting Severe Postoperative Complication in Patients With Lung Cancer and Interstitial Pneumonia

Ohsawa, Manato; Tsutani, Yasuhiro; Fujiwara, M.; Mimae, Takahiro; Miyata, Yoshihiro; Okada, Minoru

doi:10.1016/j.athoracsur.2019.11.012

Cited by 24 publications

(16 citation statements)

References 29 publications

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“…To evaluate the independent risk factors for AE of IP, a logistic regression model was used. Sex (male), presence of collagen disease, percent predicted vital capacity (%VC; ≤ 80%), percent diffusing capacity for carbon monoxide (%DLCO; ≤ 40%) [ 15 ], serum level of Krebs von den Lungen-6 (KL-6; ≥ 1000), preoperative steroid use, radiological pattern of IP (UIP pattern or not), operative time (continuous value), and anatomical resection (not wedge resection) were used in the multivariable analysis other than serum S100A4. The cutoff value of S100A4 was determined according to the receiver operating characteristic (ROC) curve predicting AE of IP.…”

Section: Methodsmentioning

confidence: 99%

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

et al. 2021

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Background Acute exacerbation (AE) of interstitial pneumonia (IP) is the most fatal complication after lung resection for lung cancer. To improve the prognosis of lung cancer with IP, the risk factors of AE of IP after lung resection should be assessed. S100 calcium-binding protein A4 (S100A4) is a member of the S100 family of proteins and is a known marker of tissue fibrosis. We examined the usefulness of S100A4 in predicting AE of IP after lung resection for lung cancer. Methods This study included 162 patients with IP findings on preoperative high-resolution computed tomography scan who underwent curative-intent lung resection for primary lung cancer between April 2007 and March 2019. Serum samples were collected preoperatively. Resected lung tissue from 76 patients exhibited usual IP (UIP) pattern in resected lung were performed immunohistochemistry (IHC). Relationship between S100A4 and the incidence of AE of IP and short-term mortality was analyzed. Results The receiver operating characteristic area under the curve for serum S100A4 to predict postoperative AE of IP was 0.871 (95% confidence interval [CI], 0.799–0.943; P < 0.001), with a sensitivity of 93.8% and a specificity of 75.3% at the cutoff value of 17.13 ng/mL. Multivariable analysis revealed that a high serum S100A4 level (> 17.13 ng/mL) was a significant risk factor for AE of IP (odds ratio, 42.28; 95% CI, 3.98–449.29; P = 0.002). A 1-year overall survival (OS) was significantly shorter in patients with high serum levels of S100A4 (75.3%) than in those with low serum levels (92.3%; P = 0.003). IHC staining revealed that fibroblasts, lymphocytes, and macrophages expressed S100A4 in the UIP area, and the stroma and fibrosis in the primary tumor expressed S100A4, whereas tumor cells did not. Conclusions Serum S100A4 had a high predictive value for postoperative AE of IP and short-term mortality after lung resection.

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Section: Methodsmentioning

confidence: 99%

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

et al. 2021

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“…To evaluate the independent risk factors for AE of IP, a logistic regression model was used. Sex (male), percent predicted vital capacity (%VC; ≤80%), percent diffusing capacity for carbon monoxide (%DLCO; ≤40%) [15], serum level of Krebs von den Lungen-6 (KL-6; ≥500), preoperative steroid use, radiological pattern of IP (UIP pattern or not), operative time (continuous value), and anatomical resection (not wedge resection) were used in the multivariable analysis other than serum S100A4. The cutoff value of S100A4 was determined according to the receiver operating characteristic (ROC) curve predicting AE of IP.…”

Section: Discussionmentioning

confidence: 99%

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

Kagimoto

Tsutani

Kushitani

et al. 2021

Preprint

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Background Acute exacerbation (AE) of interstitial pneumonia (IP) is the most fatal complication after lung resection for lung cancer. To improve the prognosis of lung cancer with IP, the risk factors of AE of IP after lung resection should be assessed. We examined the usefulness of S100 calcium-binding protein A4 (S100A4) in predicting AE of IP after lung resection for lung cancer. Methods This study included 162 patients with IP findings on preoperative high-resolution computed tomography scan who underwent curative-intent lung resection for primary lung cancer between April 2007 and March 2019. Serum samples were collected preoperatively. Resected lung tissue from 76 patients exhibited usual IP (UIP) pattern in resected lung were performed immunohistochemistry (IHC). Relationship between S100A4 and the incidence of AE of IP and short-term mortality was analyzed. Results The receiver operating characteristic area under the curve for serum S100A4 to predict postoperative AE of IP was 0.871 (95% confidence interval [CI], 0.799–0.943; P < 0.001), with a sensitivity of 93.8% and a specificity of 75.3% at the cutoff value of 17.13 ng/mL. Multivariable analysis revealed that a high serum S100A4 level (> 17.13 ng/mL) was a significant risk factor for AE of IP (odds ratio, 30.85; 95% CI, 3.77–252.21; P = 0.001). A 1-year overall survival (OS) was significantly shorter in patients with high serum levels of S100A4 (75.3%) than in those with low serum levels (92.3%; P = 0.003). IHC staining revealed that fibroblasts, lymphocytes, and macrophages expressed S100A4 in the UIP area, and the stroma and fibrosis in the primary tumor expressed S100A4, whereas tumor cells did not. Conclusions Serum S100A4 had a high predictive value for postoperative AE of IP and short-term mortality after lung resection.

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“…The surgical management of early-stage lung adenocarcinoma: is wedge resection effective? Although, several studies have compared survival outcome of wedge resection and segmentectomy (12)(13)(14)(15)(16), it is not clear which procedure is more reliable for peripheral lung nodules. Most studies have reported similar prognosis for segmentectomy and wedge resection on patients with stage IA NSCLC less than 1.0 cm (17,18), but the outcomes were unclear for 1.0-2.0 cm tumors with different consolidation-to-tumor ratio (CTR) (19)(20)(21).…”

Section: Original Articlementioning

confidence: 99%

The surgical management of early-stage lung adenocarcinoma: is wedge resection effective?

Bai

Qiu

et al. 2021

J Thorac Dis

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Background: The aim of the study was to explore the outcomes of wedge resection on patients with earlystage lung adenocarcinoma (LUAD) and further identify potential prognostic factors for these patients.Methods: A retrospective cohort of 190 patients (99 solitary LUAD and 91 multifocal LUAD) undergone wedge resection from October 2014 to September 2015 was established. Cox proportional-hazards model was used to evaluate the significant clinical prognostic factors. Further, data on patients with multifocal adenocarcinoma after segmentectomy were retrieved and propensity score matching was used to compare the outcomes of patients with multiple pulmonary nodules (MPNs) after wedge resection and segmentectomy. Results:The 5-year overall survival (OS), progression-free survival (PFS), and lung cancer specific survival of the 190 patients after wedge resection were 95.5%, 87.9%, and 97.7%, respectively. Multivariable analysis showed that MPN [hazard ratio (HR) 3.07; 95% confidence interval (CI), 1.05-8.98] and solid-dominant lesions (HR 15.87; 95% CI, 2.38-105.84) were independently associated with worse PFS. Further, propensity score matching analysis showed that MPN patients had better PFS after segmentectomy compared with wedge resection (94% vs. 80.9%, P=0.008). MPN patients were more likely to perform systematic mediastinal nodal sampling (95.6% vs. 59.3%, P<0.001) after segmentectomy compared to patients who underwent wedge resection. Conclusions: Wedge resection is a practical option for appropriately selected early-stage LUAD where tumor size is less than 2 cm and has a consolidation-to-tumor ratio ≤0.5. However, for MPNs, wedge resection may be not reliable and alternative procedures such as segmentectomy should be used.

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Predicting Severe Postoperative Complication in Patients With Lung Cancer and Interstitial Pneumonia

Cited by 24 publications

References 29 publications

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

Serum S100 calcium-binding protein A4 as a novel predictive marker of acute exacerbation of interstitial pneumonia after surgery for lung cancer

The surgical management of early-stage lung adenocarcinoma: is wedge resection effective?

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