{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T07:31:10Z","timestamp":1767857470327,"version":"3.49.0"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T00:00:00Z","timestamp":1604880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JoF"],"abstract":"<jats:p>Lung resection surgery for non-small-cell lung cancer (NSCLC) is reportedly a risk factor for developing chronic pulmonary aspergillosis (CPA). However, limited data are available regarding the development of CPA during long-term follow-up after lung cancer surgery. This study aimed to investigate the cumulative incidence and clinical factors associated with CPA development after lung cancer surgery. We retrospectively analyzed 3423 patients with NSCLC who (1) underwent surgical resection and (2) did not have CPA at the time of surgery between January 2010 and December 2013. The diagnosis of CPA was based on clinical symptoms, serological or microbiological evidences, compatible radiological findings, and exclusion of alternative diagnoses. The cumulative incidence of CPA and overall survival (OS) were estimated using the Kaplan\u2013Meier method, and a multivariable Cox proportional hazard analysis was performed to identify factors associated with CPA development. Patients were followed-up for a median of 5.83 years with a 72.3% 5-year OS rate. Fifty-six patients developed CPA at a median of 2.68 years after surgery, with cumulative incidences of 0.4%, 1.1%, 1.6%, and 3.5% at 1, 3, 5, and 10 years, respectively. Lower body mass index (BMI), smoking, underlying interstitial lung disease, thoracotomy, development of postoperative pulmonary complications 30 days after surgery, and treatment with both chemotherapy and radiotherapy were independently associated with CPA development. The cumulative incidence of CPA after surgery was 3.5% at 10 years and showed a steadily increasing trend during long-term follow-up. Therefore, increased awareness regarding CPA development is needed especially in patients with risk factors.<\/jats:p>","DOI":"10.3390\/jof6040271","type":"journal-article","created":{"date-parts":[[2020,11,10]],"date-time":"2020-11-10T10:47:28Z","timestamp":1605005248000},"page":"271","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Incidence and Risk Factors of Chronic Pulmonary Aspergillosis Development during Long-Term Follow-Up after Lung Cancer Surgery"],"prefix":"10.3390","volume":"6","author":[{"given":"Sun","family":"Shin","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0800-4324","authenticated-orcid":false,"given":"Bo-Guen","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiyeon","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pulmonology, Inje University Seoul Paik Hospital, Seoul 04551, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang-Won","family":"Um","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9207-0433","authenticated-orcid":false,"given":"Hojoong","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7815-3336","authenticated-orcid":false,"given":"Hong","family":"Kim","sequence":"additional","affiliation":[{"name":"Samsung Medical Center, Department of Thoracic Surgery, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jhingook","family":"Kim","sequence":"additional","affiliation":[{"name":"Samsung Medical Center, Department of Thoracic Surgery, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young","family":"Shim","sequence":"additional","affiliation":[{"name":"Samsung Medical Center, Department of Thoracic Surgery, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yong","family":"Choi","sequence":"additional","affiliation":[{"name":"Samsung Medical Center, Department of Thoracic Surgery, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3124-1718","authenticated-orcid":false,"given":"Byeong-Ho","family":"Jeong","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-ro 81, Gangnam-gu, Seoul 06351, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e278S","DOI":"10.1378\/chest.12-2359","article-title":"Treatment of stage I and II non-small cell lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines","volume":"143","author":"Howington","year":"2013","journal-title":"Chest"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1763","DOI":"10.1056\/NEJMoa060476","article-title":"Survival of patients with stage I lung cancer detected on CT screening","volume":"355","author":"Henschke","year":"2006","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1056\/NEJMoa1102873","article-title":"Reduced lung-cancer mortality with low-dose computed tomographic screening","volume":"365","author":"Aberle","year":"2011","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1097\/JTO.0000000000000388","article-title":"Endobronchial ultrasound versus mediastinoscopy for mediastinal nodal staging of non-small-cell lung cancer","volume":"10","author":"Um","year":"2015","journal-title":"J. Thorac. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ejcts\/ezt051","article-title":"Long-term survival in video-assisted thoracoscopic lobectomy vs open lobectomy in lung-cancer patients: A meta-analysis","volume":"44","author":"Taioli","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.1016\/j.athoracsur.2017.06.065","article-title":"Patterns of Treatment and Outcomes for Definitive Therapy of Early Stage Non-Small Cell Lung Cancer","volume":"104","author":"Kapadia","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","unstructured":"Howlader, N., Noone, A.M., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., and Lewis, D.R. (2020, November 02). SEER Cancer Statistics Review, 1975\u20132016, National Cancer Institute, Available online: https:\/\/seer.cancer.gov\/csr\/1975_2016\/results_merged\/sect_15_lung_bronchus.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1097\/JTO.0b013e3182862e7e","article-title":"Influence of postoperative infectious complications on long-term survival of lung cancer patients: A population-based cohort study","volume":"8","author":"Andalib","year":"2013","journal-title":"J. Thorac. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1136\/thx.2009.123083","article-title":"Postoperative pulmonary complications following thoracic surgery: Are there any modifiable risk factors?","volume":"65","author":"Agostini","year":"2010","journal-title":"Thorax"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1136\/thoraxjnl-2015-207697","article-title":"Long-term impact of developing a postoperative pulmonary complication after lung surgery","volume":"71","author":"Lugg","year":"2016","journal-title":"Thorax"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1183\/13993003.00583-2015","article-title":"Chronic pulmonary aspergillosis: Rationale and clinical guidelines for diagnosis and management","volume":"47","author":"Denning","year":"2016","journal-title":"Eur. Respir. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"864","DOI":"10.2471\/BLT.11.089441","article-title":"Global burden of chronic pulmonary aspergillosis as a sequel to pulmonary tuberculosis","volume":"89","author":"Denning","year":"2011","journal-title":"Bull. World Health Organ."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1183\/09031936.00054810","article-title":"Underlying conditions in chronic pulmonary aspergillosis including simple aspergilloma","volume":"37","author":"Smith","year":"2011","journal-title":"Eur. Respir. J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1801184","DOI":"10.1183\/13993003.01184-2018","article-title":"Chronic pulmonary aspergillosis commonly complicates treated pulmonary tuberculosis with residual cavitation","volume":"53","author":"Page","year":"2019","journal-title":"Eur. Respir. J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1093\/icvts\/ivv239","article-title":"Chronic pulmonary aspergillosis as a sequel to lobectomy for lung cancer","volume":"21","author":"Tamura","year":"2015","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_16","unstructured":"Edge, S.B., Byrd, D.R., Compton, C.C., Fritz, A.G., Greene, F.L., and Trotti, A. (2010). AJCC Cancer Staging Manual, Springer. [7th ed.]."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1093\/bja\/aex002","article-title":"Postoperative pulmonary complications","volume":"118","author":"Miskovic","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"811","DOI":"10.3109\/13693786.2013.806826","article-title":"Clinical characteristics and treatment outcomes of chronic pulmonary aspergillosis","volume":"51","author":"Jhun","year":"2013","journal-title":"Med. Mycol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1136\/thx.36.10.745","article-title":"Pulmonary aspergillus infection invading the pleura","volume":"36","author":"Hillerdal","year":"1981","journal-title":"Thorax"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1324","DOI":"10.1016\/j.athoracsur.2012.02.079","article-title":"Bronchial stump aspergillosis after stapled lobectomy for lung cancer","volume":"94","author":"Tokuishi","year":"2012","journal-title":"Ann. Thorac. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1016\/j.rmed.2012.01.014","article-title":"Clinical characteristics and prognosis of chronic pulmonary aspergillosis","volume":"106","author":"Ohba","year":"2012","journal-title":"Respir. Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Jhun, B.W., Jung, W.J., Hwang, N.Y., Park, H.Y., Jeon, K., Kang, E.S., and Koh, W.J. (2017). Risk factors for the development of chronic pulmonary aspergillosis in patients with nontuberculous mycobacterial lung disease. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0188716"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"5018","DOI":"10.1002\/cncr.24559","article-title":"Clinical characteristics of 45 patients with invasive pulmonary aspergillosis: Retrospective analysis of 1711 lung cancer cases","volume":"115","author":"Yan","year":"2009","journal-title":"Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1499","DOI":"10.1016\/j.jvir.2009.07.029","article-title":"Aspergilloma in a cavity formed after percutaneous radiofrequency ablation for lung cancer","volume":"20","author":"Hiraki","year":"2009","journal-title":"J. Vasc. Interv. Radiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"859","DOI":"10.1016\/j.ejcts.2007.09.012","article-title":"Late sequelae of lobectomy for primary lung cancer: Fibrobullous changes in ipsilateral residual lobes","volume":"32","author":"Tanaka","year":"2007","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1056\/NEJM200107193450306","article-title":"The influence of hospital volume on survival after resection for lung cancer","volume":"345","author":"Bach","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.rmed.2016.03.020","article-title":"Characterisation of fatigue and its substantial impact on health status in a large cohort of patients with chronic pulmonary aspergillosis (CPA)","volume":"114","author":"Muldoon","year":"2016","journal-title":"Respir. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.6004\/jnccn.2015.0140","article-title":"Survivorship in Non-Small Cell Lung Cancer: Challenges Faced and Steps Forward","volume":"13","author":"Vijayvergia","year":"2015","journal-title":"J. Natl. Compr. Canc. Netw."}],"container-title":["Journal of Fungi"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2309-608X\/6\/4\/271\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:31:07Z","timestamp":1760178667000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2309-608X\/6\/4\/271"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,9]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2020,12]]}},"alternative-id":["jof6040271"],"URL":"https:\/\/doi.org\/10.3390\/jof6040271","relation":{},"ISSN":["2309-608X"],"issn-type":[{"value":"2309-608X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,9]]}}}