Perioperative Anti-Fibrotic Treatment Prevents Acute Exacerbation of Idiopathic Pulmonary Fibrosis After Lung Cancer Surgery.

Autor: Bongiolatti S; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy., Salvicchi A; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy., Rosi E; Respiratory Medicine Unit, Careggi University Hospital, 50134 Florence, Italy., Bargagli E; Respiratory Diseases, Azienda Ospedaliero-Universitaria Senese, University of Siena, 53100 Siena, Italy., Mugnaini G; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy., Gonfiotti A; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.; Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy., Lavorini F; Respiratory Medicine Unit, Careggi University Hospital, 50134 Florence, Italy., Spagnolo P; Section of Respiratory Diseases, Padua University Hospital, 35128 Padua, Italy., Dell'Amore A; Division of Thoracic Surgery, Padua University Hospital, 35128 Padua, Italy., Rea F; Division of Thoracic Surgery, Padua University Hospital, 35128 Padua, Italy., Voltolini L; Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.; Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
Jazyk: angličtina
Zdroj: Life (Basel, Switzerland) [Life (Basel)] 2024 Nov 19; Vol. 14 (11). Date of Electronic Publication: 2024 Nov 19.
DOI: 10.3390/life14111506
Abstrakt: Background: The surgical treatment of concomitant lung cancer in patients with idiopathic pulmonary fibrosis is challenging due to the risk of life-threatening complications such as acute exacerbation development in the perioperative period. Few studies have investigated the role of anti-fibrotic drugs in this setting. The aim of this multicenter retrospective study was to evaluate the incidence of acute exacerbation, according to Collard, after lung resection in patients affected by concomitant idiopathic pulmonary fibrosis and lung cancer who were or were not on antifibrotic treatment. Secondary outcomes included: 30 and 90-day mortality and an estimation of overall and disease-free survival.
Material and Methods: The study population consisted of patients affected by idiopathic pulmonary fibrosis who received curative-intent lung surgery in three Italian academic centers between 2015 and 2022. Patients were divided into two groups based on whether they were on perioperative treatment with anti-fibrotic drugs (chronical or prophylactic use) or not. To define predictors of acute exacerbation, univariate and multivariable exact logistic regression analysis were performed. The Kaplan-Meier method with log-rank test was used to estimate survival.
Results: During the study period, n = 55 patients underwent lung resection for lung cancer, including 29 patients who were treated with antifibrotic agents. Although the sample size was small and few events were studied, the incidence of acute exacerbation was significantly lower among patient on anti-fibrotic therapy (3.4% vs. 23.1%, p = 0.044); in addition, anti-fibrotic treatment was the strong factor preventing acute exacerbation at the multivariable analysis (OR 0.089, p = 0.038). Post-operative 30- and 90-day mortality rates were not significantly lower in the anti-fibrotic treatment group (0% and 0% vs. 7.7% and 11.5%, p = 0.21 and p = 0.099, respectively). Overall and disease-free survival rates were similar.
Conclusions: Considering the limitations of this retrospective study with a small sample size, anti-fibrotic perioperative treatment was associated with reduced incidence of acute exacerbation. Based on these real-world data, this pathway could be proposed as a prophylactic treatment in patients with concomitant idiopathic pulmonary fibrosis and cancer undergoing lung resection.
Databáze: MEDLINE
Externí odkaz: