Dataset Information

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study.

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.

SUBMITTER: Hung SK

PROVIDER: S-EPMC5623431 | biostudies-literature | 2017 Sep

REPOSITORIES: biostudies-literature

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Publications

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study.

Hung Shih-Kai SK Chen Yi-Chun YC Chiou Wen-Yen WY Lai Chun-Liang CL Lee Moon-Sing MS Lo Yuan-Chen YC Chen Liang-Cheng LC Huang Li-Wen LW Chien Nai-Chuan NC Li Szu-Chi SC Liu Dai-Wei DW Hsu Feng-Chun FC Tsai Shiang-Jiun SJ Chan Michael Wy MW Lin Hon-Yi HY

BMJ open 20170927 9

<h4>Objective</h4>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.<h4>Design, setting and participants</h4>The nationwide population-based study analysed the Taiwan National Health Insurance Research Database (covered >99% ...[more]

PMID: 28963281

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Dataset Information

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study.

Objective

Design, setting and participants

Interventions/exposures

Outcomes/measures

Results

Conclusions

Publications

Irradiation enhanced risks of hospitalised pneumonopathy in lung cancer patients: a population-based surgical cohort study.

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