Tags

Type your tag names separated by a space and hit enter

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study.
BMJ Open 2017; 7(9):e015022BO

Abstract

OBJECTIVE

Pulmonary radiotherapy has been reported to increase a risk of pneumonopathy, including pneumonitis and secondary pneumonia, however evidence from population-based studies is lacking. The present study intended to explore whether postoperative irradiation increases occurrence of severe pneumonopathy in lung cancer patients.

DESIGN, SETTING AND PARTICIPANTS

The nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered >99% of Taiwanese) in a real-world setting. From 2000 to 2010, 4335 newly diagnosed lung cancer patients were allocated into two groups: surgery-RT (n=867) and surgery-alone (n=3468). With a ratio of 1:4, propensity score was used to match 11 baseline factors to balance groups.

INTERVENTIONS/EXPOSURES

Irradiation was delivered to bronchial stump and mediastinum according to peer-audited guidelines.

OUTCOMES/MEASURES

Hospitalised pneumonia/pneumonitis-free survival was the primary end point. Risk factors and hazard effects were secondary measures.

RESULTS

Multivariable analysis identified five independent risk factors for hospitalised pneumonopathy: elderly (>65 years), male, irradiation, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Compared with surgery-alone, a higher risk of hospitalised pneumonopathy was found in surgery-RT patients (HR, 2.20; 95% CI, 1.93-2.51; 2-year hospitalised pneumonia/pneumonitis-free survival, 85.2% vs 69.0%; both p<0.0001), especially in elderly males with COPD and CKD (HR, 13.74; 95% CI, 6.61-28.53; p<0.0001). Unexpectedly, we observed a higher risk of hospitalised pneumonopathy in younger irradiated-CKD patients (HR, 13.07; 95% CI, 5.71-29.94; p<0.0001) than that of elderly irradiated-CKD patients (HR, 4.82; 95% CI, 2.88-8.08; p<0.0001).

CONCLUSIONS

A high risk of hospitalised pneumonopathy is observed in irradiated patients, especially in elderly males with COPD and CKD. For these patients, close clinical surveillance and aggressive pneumonia/pneumonitis prevention should be considered. Further investigations are required to define underlying biological mechanisms, especially for younger CKD patients.

Authors+Show Affiliations

Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan.School of Medicine, Tzu Chi University, Hualien, Taiwan. Division of Nephrology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan.School of Medicine, Tzu Chi University, Hualien, Taiwan. Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan.School of Medicine, Tzu Chi University, Hualien, Taiwan. Thoracic Surgery, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.School of Medicine, Tzu Chi University, Hualien, Taiwan. Haematology-Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.School of Medicine, Tzu Chi University, Hualien, Taiwan. Department of Radiation Oncology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan.Institute of Molecular Biology, National Chung Cheng University, Chia-Yi, Taiwan. Department of Life Science, National Chung Cheng University, Chia-Yi, Taiwan. Human Epigenomics Centre, National Chung Cheng University, Chia-Yi, Taiwan.Department of Radiation Oncology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan. School of Medicine, Tzu Chi University, Hualien, Taiwan. Institute of Molecular Biology, National Chung Cheng University, Chia-Yi, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28963281

Citation

Hung, Shih-Kai, et al. "Irradiation Enhanced Risks of Hospitalised Pneumonopathy in Lung Cancer Patients: a Population-based Surgical Cohort Study." BMJ Open, vol. 7, no. 9, 2017, pp. e015022.
Hung SK, Chen YC, Chiou WY, et al. Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study. BMJ Open. 2017;7(9):e015022.
Hung, S. K., Chen, Y. C., Chiou, W. Y., Lai, C. L., Lee, M. S., Lo, Y. C., ... Lin, H. Y. (2017). Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study. BMJ Open, 7(9), pp. e015022. doi:10.1136/bmjopen-2016-015022.
Hung SK, et al. Irradiation Enhanced Risks of Hospitalised Pneumonopathy in Lung Cancer Patients: a Population-based Surgical Cohort Study. BMJ Open. 2017 Sep 27;7(9):e015022. PubMed PMID: 28963281.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study. AU - Hung,Shih-Kai, AU - Chen,Yi-Chun, AU - Chiou,Wen-Yen, AU - Lai,Chun-Liang, AU - Lee,Moon-Sing, AU - Lo,Yuan-Chen, AU - Chen,Liang-Cheng, AU - Huang,Li-Wen, AU - Chien,Nai-Chuan, AU - Li,Szu-Chi, AU - Liu,Dai-Wei, AU - Hsu,Feng-Chun, AU - Tsai,Shiang-Jiun, AU - Chan,Michael Wy, AU - Lin,Hon-Yi, Y1 - 2017/09/27/ PY - 2017/10/1/entrez PY - 2017/10/1/pubmed PY - 2018/6/9/medline KW - chronic kidney disease KW - lung cancer KW - pneumonia KW - pneumonitis KW - propensity score match. KW - radiotherapy SP - e015022 EP - e015022 JF - BMJ open JO - BMJ Open VL - 7 IS - 9 N2 - OBJECTIVE: Pulmonary radiotherapy has been reported to increase a risk of pneumonopathy, including pneumonitis and secondary pneumonia, however evidence from population-based studies is lacking. The present study intended to explore whether postoperative irradiation increases occurrence of severe pneumonopathy in lung cancer patients. DESIGN, SETTING AND PARTICIPANTS: The nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered >99% of Taiwanese) in a real-world setting. From 2000 to 2010, 4335 newly diagnosed lung cancer patients were allocated into two groups: surgery-RT (n=867) and surgery-alone (n=3468). With a ratio of 1:4, propensity score was used to match 11 baseline factors to balance groups. INTERVENTIONS/EXPOSURES: Irradiation was delivered to bronchial stump and mediastinum according to peer-audited guidelines. OUTCOMES/MEASURES: Hospitalised pneumonia/pneumonitis-free survival was the primary end point. Risk factors and hazard effects were secondary measures. RESULTS: Multivariable analysis identified five independent risk factors for hospitalised pneumonopathy: elderly (>65 years), male, irradiation, chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). Compared with surgery-alone, a higher risk of hospitalised pneumonopathy was found in surgery-RT patients (HR, 2.20; 95% CI, 1.93-2.51; 2-year hospitalised pneumonia/pneumonitis-free survival, 85.2% vs 69.0%; both p<0.0001), especially in elderly males with COPD and CKD (HR, 13.74; 95% CI, 6.61-28.53; p<0.0001). Unexpectedly, we observed a higher risk of hospitalised pneumonopathy in younger irradiated-CKD patients (HR, 13.07; 95% CI, 5.71-29.94; p<0.0001) than that of elderly irradiated-CKD patients (HR, 4.82; 95% CI, 2.88-8.08; p<0.0001). CONCLUSIONS: A high risk of hospitalised pneumonopathy is observed in irradiated patients, especially in elderly males with COPD and CKD. For these patients, close clinical surveillance and aggressive pneumonia/pneumonitis prevention should be considered. Further investigations are required to define underlying biological mechanisms, especially for younger CKD patients. SN - 2044-6055 UR - https://www.unboundmedicine.com/medline/citation/28963281/Irradiation_enhanced_risks_of_hospitalised_pneumonopathy_in_lung_cancer_patients:_a_population-based_surgical_cohort_study L2 - http://bmjopen.bmj.com/cgi/pmidlookup?view=long&amp;pmid=28963281 DB - PRIME DP - Unbound Medicine ER -