• Naozumi Hashimoto, Shingo Iwano, Koji Kawaguchi, Takayuki Fukui, Koichi Fukumoto, Shota Nakamura, Shunsuke Mori, Koji Sakamoto, Kenji Wakai, Kohei Yokoi, and Yoshinori Hasegawa.
• Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. Electronic address: hashinao@med.nagoya-u.ac.jp.
• Ann. Thorac. Surg. 2016 Aug 1; 102 (2): 440-7.

BackgroundThere is only limited information on the clinical impact of combined pulmonary fibrosis and emphysema (CPFE) on postoperative and survival outcomes among patients with resected lung cancer.MethodsIn a retrospective analysis, data were reviewed from 685 patients with resected lung cancer between 2006 and 2011. The clinical impact of thin-section computed tomography (TSCT)-determined emphysema, fibrosis, and CPFE on postoperative and survival outcomes was evaluated.ResultsThe emphysema group comprised 32.4% of the study population, the fibrosis group 2.8%, and the CPFE group 8.3%. The CPFE group had a more advanced pathologic stage and higher prevalence of squamous cell carcinoma as compared with the normal group without emphysema or fibrosis findings on TSCT. The incidence of postoperative complications was significantly higher in the CPFE group. Overall, the 30-day mortality in the CPFE group was 5.3%. Cancer recurrence at pathologic stage I and death due to either cancer or other causes were significantly higher in the CPFE group. Survival curves indicated that a finding of CPFE was associated with worse overall survival for patients with any stage disease. Multivariate analysis suggested that pathologic stage and CPFE were independent factors associated with worse overall survival. The adjusted hazard ratio of overall survival for the CPFE group versus the normal group was 2.990 (95% confidence interval: 1.801 to 4.962).ConclusionsAmong patients with resected lung cancer, the presence of TSCT-determined CPFE might predict worse postoperative and survival outcomes.Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

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