大型临床肺癌筛查队列中的肺间质异常：与死亡率和ILD 诊断的关系。
Interstitial lung abnormalities in a large clinical lung cancer screening cohort: association with mortality and ILD diagnosis.
机构信息
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Lahey Hospital and Medical Center, Burlington, MA, 01805, USA.
Tufts University School of Medicine, Boston, MA, 02111, USA.
出版信息
Respir Res. 2023 Feb 14;24(1):49. doi: 10.1186/s12931-023-02359-9.
BACKGROUND
Interstitial lung abnormalities (ILA) are CT findings suggestive of interstitial lung disease in individuals without a prior diagnosis or suspicion of ILD. Previous studies have demonstrated that ILA are associated with clinically significant outcomes including mortality. The aim of this study was to determine the prevalence of ILA in a large CT lung cancer screening program and the association with clinically significant outcomes including mortality, hospitalizations, cancer and ILD diagnosis.
METHODS
This was a retrospective study of individuals enrolled in a CT lung cancer screening program from 2012 to 2014. Baseline and longitudinal CT scans were scored for ILA per Fleischner Society guidelines. The primary analyses examined the association between baseline ILA and mortality, all-cause hospitalization, and incidence of lung cancer. Kaplan-Meier plots were generated to visualize the associations between ILA and lung cancer and all-cause mortality. Cox regression proportional hazards models were used to test for this association in both univariate and multivariable models.
RESULTS
1699 subjects met inclusion criteria. 41 (2.4%) had ILA and 101 (5.9%) had indeterminate ILA on baseline CTs. ILD was diagnosed in 10 (24.4%) of 41 with ILA on baseline CT with a mean time from baseline CT to diagnosis of 4.47 ± 2.72 years. On multivariable modeling, the presence of ILA remained a significant predictor of death, HR 3.87 (2.07, 7.21; p < 0.001) when adjusted for age, sex, BMI, pack years and active smoking, but not of lung cancer and all-cause hospital admission. Approximately 50% with baseline ILA had progression on the longitudinal scan.
CONCLUSIONS
ILA identified on baseline lung cancer screening exams are associated with all-cause mortality. In addition, a significant proportion of patients with ILA are subsequently diagnosed with ILD and have CT progression on longitudinal scans.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov; No.: NCT04503044.
背景
间质性肺异常（ILA）是指在没有间质性肺疾病（ILD）既往诊断或疑似的情况下，CT 检查发现的提示间质性肺疾病的肺部异常。先前的研究表明，ILA 与包括死亡率在内的临床重要结局有关。本研究的目的是确定在一项大型 CT 肺癌筛查计划中 ILA 的患病率，以及其与包括死亡率、住院、癌症和 ILD 诊断在内的临床重要结局的关联。
方法
这是一项对 2012 年至 2014 年间参加 CT 肺癌筛查计划的个体进行的回顾性研究。根据 Fleischner 学会指南，对基线和纵向 CT 扫描进行 ILA 评分。主要分析检查了基线 ILA 与死亡率、全因住院和肺癌发生率之间的关系。生成 Kaplan-Meier 图以直观显示 ILA 与肺癌和全因死亡率之间的关联。使用 Cox 回归比例风险模型在单变量和多变量模型中检验这种关联。
结果
共有 1699 名符合纳入标准的患者。41 名（2.4%）患者在基线 CT 上有 ILA，101 名（5.9%）患者有不确定的 ILA。在基线 CT 上有 ILA 的 41 名患者中有 10 名（24.4%）被诊断为 ILD，从基线 CT 到诊断的平均时间为 4.47±2.72 年。多变量建模后，ILA 的存在仍然是死亡的显著预测因素，在校正年龄、性别、BMI、吸烟包年和主动吸烟后，风险比为 3.87（2.07，7.21；p<0.001），但与肺癌和全因住院无关。大约 50%基线 ILA 的患者在纵向扫描中进展。
结论
在基线肺癌筛查检查中发现的 ILA 与全因死亡率相关。此外，相当一部分有 ILA 的患者随后被诊断为 ILD，并在纵向扫描中出现 CT 进展。
试验注册
ClinicalTrials.gov；编号：NCT04503044。
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