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━━ Purpose. Idiopathic interstitial pneumonia (IIP) is associated with an increased risk of lung cancer. However, the contribution of anticancer therapies is unclear because these therapies, including surgery, may trigger acute exacerbation (AE), and are confounded by the progressive nature and poor prognosis of IIP. The purpose of the present study was to identify the predictors of both AE and long-term survival after surgical resection for lung cancer. Methods.We retrospectively analyzed the cases of 1,763 non-small cell lung cancer patients who underwent pulmonary resection between January 2000 and December 2009 after presenting with a clinical diagnosis of IIP at 61 institutions in Japan. Results. AE occurred in 9.3% of the patients; the mortality rate was 43.9%. A multivariate analysis identified the following seven risk factors for AE: anatomical surgical resection, male sex, a history of AE, preoperative steroid use, a high serum level of sialylated carbohydrate antigen KL-6, the usual appearance of interstitial pneumonia on CT, and a reduced percent predicted vital capacity (%VC). Unfortunately, no effective prophylactic medications could be identified. The overall 5-year survival rate was 40%, which was poorer than that in the historical control. The multivariate analysis revealed that wedge resection, %VC <80% and lower lobe cancer were predictors of poor survival. Of note, wedge resection reduced the incidence of death due to respiratory failure but resulted in a poorer long-term prognosis than lobectomy because of the higher incidence of cancer recurrence. We further developed a simple risk scoring system for predicting AE by giving weight to each of the seven risk factors. Conclusions.We identified seven risk factors for AE and three predictors of a poor prognosis after surgical resection for lung cancer associated with IIP. We further developed a simple risk scoring system for predicting AE. Using this risk scoring system, surgeons can preoperatively assess the risk of AE in each patient and may choose an appropriate surgical procedure in routine clinical practice. (JJLC. 2015;55:900-904) KEY WORDS━━ Lung cancer, Idiopathic pulmonary fibrosis, Idiopathic interstitial pneumonia, Interstitial pneumonia, Acute exacerbation Reprints: Hiroshi Date, Department of Thoracic Surgery, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto 606-8507, Japan (e-mail: hdate@kuhp.kyoto-u.ac.jp). 要旨━━目的.特発性間質性肺炎は肺癌発症リスクを 増大させる.しかしながら,外科治療を含む抗癌治療の 効果は明白ではない.特発性間質性肺炎の急性増悪を引 き起こすかもしれないし,特発性間質性肺炎自体が進行 性であり予後不良であるためである.そこで,我々は肺 癌術後急性増悪を引き起こす予測因子と長期予後因子を 同定することを目的に研究を行った.方法.2000 年から 2009 年に日本の 61 施設で手術した 1,763 名の間質性肺 炎を合併した非小細胞肺癌患者を後ろ向きに検討した. 結果.急性増悪は 9.3%に発症し,その死亡率は 43.9% 1京都大学大学院医学研究科器官外科学講座呼吸器外科;2札幌 医科大学呼吸器外科;3杏林大学呼吸器外科. 別刷請求先:伊達洋至,京都大学呼吸器外科,〒606-8507 京都 市左京区聖護院川原町 54 (e-mail: hdate@kuhp.kyoto-u.ac.jp). ※第 55 回日本肺癌学会学術集会シンポジウム 4「肺がんの背景 に見られる間質性肺炎をどう診断しマネージするか?<学術委員 会企画>」. (肺癌.2015;55:900-904) 2015 The Japan Lung Cancer Society Surgical Management for Lung Cancer Patients with Interstitial Pneumonia―Date et al Japanese Journal of Lung Cancer―Vol 55, No 6, Oct 20, 2015―www.haigan.gr.jp 901 であった.多変量解析では,以下の 7つの急性増悪発症 リスク因子が同定された.解剖学的切除,男性,急性増 悪の既往,術前ステロイド使用歴,KL-6 高値,CT上 UIP (通常型間質性肺炎)パターン,%VC低値である.残念 ながら,有効な予防投薬は見いだせなかった.全体の 5 年生存率は 40%であり,歴史的コントロールよりも不良 であった.多変量解析では,楔状切除,%VC<80%,下 葉発生肺癌が予後不良因子であった.注目すべきは,楔 状切除は呼吸不全死を減少させたが,肺葉切除よりも癌 再発の頻度が高いために長期予後は不良であった.我々 は,さらに 7つのリスク因子に重みを与えることにより, 急性増悪を予測する簡単なリスクスコアを考案した.結 論.我々は,7つの急性増悪リスク因子,3つの長期予後 不良因子を同定し,リスクスコアを考案した.外科医は, それぞれの患者の急性増悪リスクを術前に予測すること ができ,適切な手術術式を選択することができるかも知 れない. 索引用語━━肺癌,特発性肺線維症,特発性間質性肺炎, 間質性肺炎,急性増悪

How to Diagnose and Manage Lung Cancer Patients with Interstitial Pneumonia -Surgical Management-