F-099
REDUCED RISK OF POSTOPERATIVE ACUTE EXACERBATION IN PATIENTS WITH LUNG CANCER HARBORING IDIOPATHIC PULMONARY FIBROSIS WHO UNDERWENT PERIOPERATIVE PIRFENIDONE TREATMENT

Objectives: Acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) is a life-threatening complication of lung cancer surgery for patients with IPF, and no effective prophylaxis for AE-IPF has ever been reported. A Japanese large cohort study revealed seven risk factors for AE-IPF after lung cancer surgery (history of AE, surgical procedure, UIP, male, steroid, elevated KL-6 and low vital capacity), and a risk scoring system has recently been advocated. A recent Japanese multi-institutional prospective trial (WJOG6711L) showed an encouraging result of perioperative pirfenidone treatment (PPT) for prevention of AE-IPF; however, it was a single-arm trial and background risk evaluation using the scoring system was not yet performed. In this study, we evaluate the risk scores and incidence of AE-IPF in our consecutive series of lung cancer patients with IPF who underwent surgery with or without PPT.

Methods: Thirty-one PPT cases and 19 historical controls were retrospectively investigated for their clinical characteristics including risk scores and incidences of AE-IPF after surgery.

Results: Between the PPT and control groups, there were no difference of age (68 ± 2 vs 69 ± 2 years), pack year (62 ± 6 vs 48 ± 8), gender (28 males/3 females vs 18/1), vital capacity (95 ± 3 vs 103 ± 4% predicted), KL-6 (900 ± 136 vs 676 ± 184 U/ml), procedure (23 anatomical resection/8 wedge resection vs 18/1), or risk score (10.5 ± 0.4 vs 11.2 ± 0.5). The incidences of AE-IPF for the PPT/control groups were 0.0/10.5% during 30 postoperative days (P = 0.07), and 21.1/3.2% during 90 postoperative days (P = 0.04).

Conclusions: Prophylactic effect of PPT for postoperative AE-IPF was strongly suggested. Since 11 points of risk score was reported to predict 10.7% of AE-IPF occurrence within 30 postoperative days, our results for the control group clearly validate the scoring system.

Disclosure: I. Yoshino: Received a research grant from Shionogi & Co. Ltd for another purpose than this study.