Follow-Up of Surgical or Nonsurgical Patients with Pulmonary Cryptococcosis: A Real-World Study

Abstract

Background

Surgical and medical treatments are applied to pulmonary cryptococcosis (PC) in the real world, while the prognosis of different therapies is uncertain. This study investigated diagnosis, real-world therapy, follow-up outcomes, and prognosis factors, aiming to deepen our understanding of PC.

Methods

Patients pathologically diagnosed with PC were retrospectively reviewed and followed up. Further comparisons and subgroup analyses were conducted in surgical and nonsurgical treatment individuals. Univariable and multivariable logistic regression methods were used to explore the risk factors associated with treatment failure.

Results

One hundred and sixty-three patients were included in this study, of whom 92 underwent surgical removal of VATS or open lung surgery (68 of them received postoperative antifungal treatment) and 71 got antifungal drugs only. Compared with nonsurgical patients, surgical patients were more immunocompetent (73 [79.3%] cases vs 33 [46.5%]), showed milder symptoms and more limited pulmonary lesions. Although they had instant treatment response owing to lesions resection, there is no significant advantage in the rate of treatment failure. Multivariable regression showed independent predictive factors associated with treatment failure were polymorphonuclear (PMN)>6.30*10⁹/L, albumin (Alb) <40g/L and antifungal dosage <400mg/d. Further analysis among patients with different immune statuses or symptoms demonstrated that sufficient antifungal dosage could reduce the rate of treatment failure.

Conclusion

PC showed variable and nonspecific clinical features. PC patients with limited nodules/masses and mild symptoms often led to misdiagnosis and unnecessary lung resections. The potential risk factors including higher PMN and hypoalbuminemia could help clinicians to identify PC patients with poor treatment efficiency at an early stage. To note, sufficient antifungal dosage may improve the treatment outcomes.

Keywords:

• pulmonary cryptococcosis
• diagnosis
• antifungal treatment
• clinical features
• surgery

Acknowledgments

The authors thank Y. Wu and J. Chen (Department of Radiology, the Second Xiangya Hospital of Central South University, China) for reviewing the radiological images. We appreciate help to review the histological section by D. Li, X. She and Y. Li (Department of Pathology, the Second Xiangya Hospital of Central South University, China).

Disclosure

The authors report no conflicts of interest in relation to this work.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China [grant numbers 81873410 and 82070049], the National Key R&D Program of China [grant number 2016YFC1304700], and the Fundamental Research Funds for the Central Universities of Central South University [grant number 2018zzts046].