Prognostic impacts of interstitial lung abnormalities on outcomes following resection for lung cancer.

Introduction: The clinical significance of interstitial lung abnormalities in patients with lung cancer undergoing curative resection remains largely unstudied. This study aimed to evaluate the prevalence of these findings among patients with lung cancer undergoing resection and assess their impact on postoperative complications and long-term survival.

Methods: This single-centre retrospective study included patients who underwent resection from 2008 to 2020. Patients with a history of lung cancer, previous lung resection or clinically evident interstitial lung disease before cancer detection were excluded. Preoperative chest scans were reviewed for interstitial lung abnormalities according to established criteria. Associations between these abnormalities and postoperative outcomes, as well as long-term survival, were analysed using multivariate models.

Results: Among 1802 patients with available preoperative scans, 114 (6.3%) had interstitial lung abnormalities, including 17 (0.9%) with a usual interstitial pneumonia-like pattern. Interstitial lung abnormalities were associated with older age, female sex and smoking history. Although their presence did not significantly increase the risk of postoperative complications or 30-day mortality, interstitial lung abnormalities were linked to higher long-term mortality (92 vs 61 deaths/1000 person-years, HR 1.47; 95% CI 1.05 to 2.05). The usual interstitial pneumonia-like patterns were significantly associated with increased long-term mortality (HR 2.84; 95% CI 1.36 to 5.91), whereas other patterns were not (HR 0.98; 95% CI 0.63 to 1.54).

Conclusions: Interstitial lung abnormalities are common in patients with lung cancer undergoing curative surgery and are linked to demographic and smoking-related factors. While they do not significantly impact short-term surgical outcomes, usual interstitial pneumonia-like pattern is associated with worse long-term survival.