Pre-surgical clinico-radiologic-pathological risks for post-surgical acute exacerbation of interstitial pneumonia in resectable lung cancer patients

<bold>Introduction:</bold> Post-surgical acute exacerbation (AE) of fibrosing interstitial lung diseases (fILD) in patients with resectable lung cancer is an unpredictable issue. <bold>Aim:</bold> To identify the risks for post-surgical AE with presurgical clinico-radiological findings and the pathology evaluated from resected specimens. <bold>Methods:</bold> Patients who did or did not occur post-surgical AE (8 and 16 patients, respectively) were retrospectively enrolled from 5 ILD specialized centres. The patients were stratified according to previously reported pre-surgical AE risk scores ranking with mild, intermediate, or high risk. The scoring system consists of history of AE, surgical procedure (wedge resection or others), usual interstitial pneumonia (UIP) pattern on high resolution computed tomography (HRCT), presurgical steroid use, male gender, serum Krebs von den Lugen-6 (>1,000 U/mL) and predicted vital capacity≦80%. Clinico-radiological findings such as smoking status, serum fibrotic markers, Gender-Age-Physiology (GAP) score, and HRCT fibrosis patterns, were compared. Pathology of resected specimens related to ILDs was evaluated. Mean difference with both groups was statistically evaluated. <bold>Results:</bold> GAP score (p<0.0001) and the area ratio of UIP pattern fibrosis to whole fibrotic lesion on HRCT(P=0.034) were significant clinico-radiological risks for post-surgical AE. Incorporated type of intraluminal organization, cellular interstitial pneumonia, and denuded alveolar epithelium from pathologic evaluation were possible candidates for the risk of AE. <bold>Conclusions:</bold> Careful presurgical evaluation and early confirmation of pathology are necessary for patients having AE risks.