Department of Clinical and Experimental, Biomedical Sciences "Mario Serio, " University of Florence, Viale Pieraccini, 50134, Florence, Italy.
Division of Epidemiology and Clinical Governance, Institute for Study, PRevention and netwoRk in Oncology (ISPRO), Florence, Italy.
Eur Radiol. 2023 May;33(5):3115-3123. doi: 10.1007/s00330-023-09504-4. Epub 2023 Mar 1.
Cardiovascular disease (CVD), lung cancer (LC), and respiratory diseases are main causes of death in smokers and former smokers undergoing low-dose computed tomography (LDCT) for LC screening. We assessed whether quantification of pulmonary emphysematous changes at baseline LDCT has a predictive value concerning long-term mortality.
In this longitudinal study, we assessed pulmonary emphysematous changes with densitometry (volume corrected relative area below - 950 Hounsfield units) and coronary artery calcifications (CAC) with a 0-3 visual scale in baseline LDCT of 524 participants in the ITALUNG trial and analyzed their association with mortality after 13.6 years of follow-up using conventional statistics and a machine learning approach.
Pulmonary emphysematous changes were present in 32.3% of subjects and were mild (6% ≤ RA950 ≤ 9%) in 14.9% and moderate-severe (RA950 > 9%) in 17.4%. CAC were present in 67% of subjects (mild in 34.7%, moderate-severe in 32.2%). In the follow-up, 81 (15.4%) subjects died (20 of LC, 28 of other cancers, 15 of CVD, 4 of respiratory disease, and 14 of other conditions). After adjusting for age, sex, smoking history, and CAC, moderate-severe emphysema was significantly associated with overall (OR 2.22; 95CI 1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality. Machine learning showed that RA950 was the best single feature predictive of overall and CVD mortality.
Moderate-severe pulmonary emphysematous changes are an independent predictor of long-term overall and CVD mortality in subjects participating in LC screening and should be incorporated in the post-test calculation of the individual mortality risk profile.
• Densitometry allows quantification of pulmonary emphysematous changes in low-dose CT examinations for lung cancer screening. • Emphysematous lung density changes are an independent predictor of long-term overall and cardio-vascular disease mortality in smokers and former smokers undergoing screening. • Emphysematous changes quantification should be included in the post-test calculation of the individual mortality risk profile.
心血管疾病（CVD）、肺癌（LC）和呼吸系统疾病是接受低剂量计算机断层扫描（LDCT）筛查肺癌的吸烟者和前吸烟者的主要死亡原因。我们评估了基线 LDCT 上肺肺气肿变化的量化是否具有预测长期死亡率的价值。
在这项纵向研究中，我们使用密度测定法（体积校正的低于-950 个单位的相对面积）评估了 ITALUNG 试验中 524 名参与者基线 LDCT 上的肺肺气肿变化，并使用常规统计学和机器学习方法分析了它们与 13.6 年后死亡率的关系。
32.3%的受试者存在肺气肿改变，6%≤RA950≤9%为轻度，17.4%为中重度。67%的受试者存在 CAC（轻度 34.7%，中重度 32.2%）。在随访期间，81 名（15.4%）受试者死亡（20 例 LC，28 例其他癌症，15 例 CVD，4 例呼吸系统疾病，14 例其他疾病）。调整年龄、性别、吸烟史和 CAC 后，中重度肺气肿与总死亡率（OR 2.22；95%CI 1.34-3.70）和 CVD 死亡率（OR 3.66；95%CI 1.21-11.04）显著相关。机器学习显示 RA950 是预测总死亡率和 CVD 死亡率的最佳单一特征。
在接受 LC 筛查的受试者中，中重度肺气肿改变是长期总死亡率和 CVD 死亡率的独立预测因子，应纳入个体死亡率风险概况的 post-test 计算。
密度测定法允许对肺癌筛查的 LDCT 检查中的肺气肿进行量化。
肺气肿肺部密度变化是吸烟者和前吸烟者接受筛查时长期总死亡率和心血管疾病死亡率的独立预测因子。
应将肺气肿变化的量化纳入个体死亡率风险概况的 post-test 计算。
