Predicting outcome after lung resection for invasive pulmonary aspergillosis in patients with neutropenia.
Predicting outcome after lung resection for invasive pulmonary aspergillosis in patients with neutropenia.
复制标题
预测中性粒细胞减少症患者侵袭性肺曲霉病肺切除术后的结果。
作者：
P. Matt;F. Bernet;J. Habicht;F. Gambazzi;A. Gratwohl;H. Zerkowski;M. Tamm
研究目标
目的探讨影响中性粒细胞减少症患者肺切除术后生存的因素，以帮助选择最有可能取得成功的患者。
设计
单中心回顾性研究。
设置
大学医院血液肿瘤隔离科和胸外科。
病人
41例血液病和疑似IPA患者行肺切除。
干预措施
肺叶切除23例，楔形切除16例，眼球摘除2例。
结果
30天内病死率为10%(4/41)。围术期主要并发症发生率为10%。1例死亡可能与手术(胸膜曲霉病)有关。在确诊为曲霉病的患者中，87.1%的患者清除了感染，但真菌复发的比例为10%。术后6个月、12个月和5年的总存活率分别为65%、58%和40%。术后6个月和12个月，幸存者和死亡者的基线特征和术中数据没有显著差异。围手术期并发症对预后无显著影响。对12个月存活率的多因素分析显示，基础血液病的变量、进展或复发(相对风险[RR]，4.64；95%可信区间[CI]，3.51至5.77；P<；0.0001)、真菌复发(RR，5.06；95%CI，3.83至6.28；P<；0.0001)，以及较小程度的潜在血液病类型(P<；0.018)是患者生存的最重要预测因素。
结论
肺切除治疗IPA是可行的，手术风险可接受。而10%的围手术期死亡率相当可观，非手术死亡率据报道在30%至90%之间。真菌感染在80%的患者中被清除。如果潜在的血液病得到控制，中长期生存是可以实现的。目前还不可能确定一组IPA患者最有可能从肺切除中受益。
STUDY OBJECTIVES
To investigate the factors that predict survival after lung resection for invasive pulmonary aspergillosis (IPA) in patients with neutropenia, in order to assist the selection of patients who are most likely to have a successful outcome.
DESIGN
Retrospective single-center study.
SETTING
University hospital hemato-oncologic isolation unit and division of thoracic surgery.
PATIENTS
Forty-one patients with hematologic disease and suspected IPA who underwent lung resection.
INTERVENTIONS
Lobectomy (n = 23), wedge resection (n = 16), and enucleation (n = 2).
RESULTS
Mortality within 30 days was 10% (4 of 41 patients). Major perioperative complications occurred in 10%. One death was possibly related to surgery (pleural aspergillosis). Of the patients with proven aspergillosis, 87.1% were cleared of infection, but fungal relapse occurred in 10%. Overall survival was 65% at 6 months, 58% at 12 months, and 40% at 5 years after surgery. Baseline characteristics and intraoperative data did not differ significantly between survivors and nonsurvivors at 6 months or 12 months after surgery. Perioperative complications did not significantly influence the outcome. Multivariate analysis of 12-month survival revealed that the variables, progression, or recurrence of the underlying hematologic disease (relative risk [RR], 4.64; 95% confidence interval [CI], 3.51 to 5.77; p < 0.0001), fungal relapse (RR, 5.06; 95% CI, 3.83 to 6.28; p < 0.0001), and to a minor extent the type of the underlying hematologic disease (p < 0.018) were the most important predictors of patient survival.
CONCLUSIONS
Lung resection for IPA is feasible with an acceptable operative risk. While at 10%, the perioperative mortality is considerable; the nonsurgical mortality is reported to be between 30% and 90%. Fungal infection is cleared in > 80% of patients. Mid- to long-term survival can be achieved if the underlying hematologic disease is under control. It is not yet possible to define a group of patients with IPA who are most likely to benefit from lung resection.
影响因子：
158.5
作者：
Herbrecht, R;Denning, DW;de Pauw, B
通讯作者：
de Pauw, B