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Background <p>Unilateral upper-lung field pulmonary fibrosis (upper-PF) can occur on the operative side after lung cancer surgery. It is reportedly associated with pleural effusion at 6&#xa0;months post-surgery (PE-6mo), but the perioperative risk factors for PE-6mo and the cumulative incidence of upper-PF remain unclear.</p> Methods <p>We retrospectively reviewed all patients with lung cancer who underwent radical surgical resection between 2008 and 2016. Perioperative characteristics were compared based on the presence of PE-6mo. The cumulative incidence of upper-PF in patients with PE-6mo was estimated using a competing risk analysis.</p> Results <p>Of the 587 patients, 160 (27.2%) had PE-6mo. Multivariate analysis identified age &gt; 70&#xa0;years, body mass index &lt; 22, thoracotomy, lobectomy, pulmonary apical cap, and adjuvant chemotherapy as independent risk factors for PE-6mo. Among 115 patients evaluable by chest CT for 2&#xa0;years, 25 (21.7%) subsequently developed upper-PF (upper-PF group), while 90 did not (non-upper-PF group). The 3-, 5-, and 10-year cumulative incidences of upper-PF were 11.5%, 16.4%, and 24.6%. The upper-PF group more commonly had prolonged pleural effusion at 2&#xa0;years than the non-upper-PF group (21/25 vs. 51/90, <i>p</i> = 0.018). Furthermore, pleural thickening was already evident at 6&#xa0;months in the upper-PF group (15/25 vs. 18/90, <i>P</i> &lt; 0.001) and thereafter. For patients with pleural thickening at 6&#xa0;months, the 3-, 5-, and 10-year cumulative incidences of upper-PF were 24.2%, 35.0%, and 51.8%.</p> Conclusion <p>Prolonged pleural effusion with pleural thickening was a common phenomenon in patients who later developed upper-PF after surgery and may therefore be a strong postoperative indicator of upper-PF development.</p>

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Unilateral upper-lung field pulmonary fibrosis radiologically consistent with pleuroparenchymal fibroelastosis after lung cancer surgery: prolonged pleural effusion and pleural thickening as early postoperative indicators

  • 期刊论文

  • 发表日期：

    2026年6月24日

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  • Akimasa Sekine,
  • Kenji Inafuku,
  • Masashi Nishimura,
  • Tsuneyuki Oda,
  • Ryo Okuda,
  • Hiromasa Arai,
  • Harumi Koizumi,
  • Yusuke Saigusa,
  • Tomohisa Baba,
  • Shigeru Komatsu,
  • Eri Hagiwara,
  • Tae Iwasawa,
  • Takashi Ogura

摘要

Background

Unilateral upper-lung field pulmonary fibrosis (upper-PF) can occur on the operative side after lung cancer surgery. It is reportedly associated with pleural effusion at 6 months post-surgery (PE-6mo), but the perioperative risk factors for PE-6mo and the cumulative incidence of upper-PF remain unclear.

Methods

We retrospectively reviewed all patients with lung cancer who underwent radical surgical resection between 2008 and 2016. Perioperative characteristics were compared based on the presence of PE-6mo. The cumulative incidence of upper-PF in patients with PE-6mo was estimated using a competing risk analysis.

Results

Of the 587 patients, 160 (27.2%) had PE-6mo. Multivariate analysis identified age > 70 years, body mass index < 22, thoracotomy, lobectomy, pulmonary apical cap, and adjuvant chemotherapy as independent risk factors for PE-6mo. Among 115 patients evaluable by chest CT for 2 years, 25 (21.7%) subsequently developed upper-PF (upper-PF group), while 90 did not (non-upper-PF group). The 3-, 5-, and 10-year cumulative incidences of upper-PF were 11.5%, 16.4%, and 24.6%. The upper-PF group more commonly had prolonged pleural effusion at 2 years than the non-upper-PF group (21/25 vs. 51/90, p = 0.018). Furthermore, pleural thickening was already evident at 6 months in the upper-PF group (15/25 vs. 18/90, P < 0.001) and thereafter. For patients with pleural thickening at 6 months, the 3-, 5-, and 10-year cumulative incidences of upper-PF were 24.2%, 35.0%, and 51.8%.

Conclusion

Prolonged pleural effusion with pleural thickening was a common phenomenon in patients who later developed upper-PF after surgery and may therefore be a strong postoperative indicator of upper-PF development.