Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, 5000 Odense C, Denmark.
Department of Clinical Research, University of Southern Denmark, 5000 Odense C, Denmark; Laboratory of Radiation Physics, Department of Oncology, Odense University Hospital, 5000 Odense C, Denmark.
Radiother Oncol. 2023 Aug;185:109719. doi: 10.1016/j.radonc.2023.109719. Epub 2023 May 29.
Coronary artery calcium score (CACs) is an excellent marker for survival in non-cancer patients, but its role in locally advanced non-small cell lung cancer (LA-NSCLC) patients remains uncertain. In this study, we hypothesize that CACs is a prognostic marker for survival in a competing risk analysis in LA-NSCLC patients treated with definitive radiotherapy.
We included 644 patients with LA-NSCLC treated in 2014-2015 in Denmark. Baseline patient characteristics were derived from the Danish Lung Cancer Registry. Radiotherapy planning CT scans were used for manual CACs measurements, and the patients were divided into four groups, CACs 0, 1-99, 100-399, and ≥400. A multivariable Cox model utilizing bootstrapping for cross-validation modeled overall survival (OS).
The median follow-up time was seven years, and the median OS was 26 months (95% CI 24-29). Within each CAC group 0, 1-99, 100-399, and ≥400 were 172, 182, 143, and 147 patients, respectively. In the univariable analysis, the survival decreased with increasing CACs. However, after adjustment for age, PS, radiotherapy dose, and logarithmic GTV, CACs did not have a statistically significant impact on OS with hazard ratios of 1.04 (95% CI 0.85-1.28), 1.11 (95%CI 0.89-1.43), and 1.16 (95%CI 0.92-1.47) for CACs 1-99, CACs 100-399 and ≥400, respectively. Elevated CACs was observed in 73 % of the patients suggesting a high risk of cardiac comorbidity before radiotherapy.
CACs did not add prognostic information to our population's classical risk factors, such as tumor volume, performance status, and age; the lung cancer has the highest priority despite the risk of baseline cardiac comorbidity.
冠状动脉钙评分（CACs）是非癌症患者生存的极佳标志物，但在局部晚期非小细胞肺癌（LA-NSCLC）患者中的作用尚不确定。在这项研究中，我们假设 CACs 是接受确定性放射治疗的 LA-NSCLC 患者在竞争风险分析中的预后标志物。
我们纳入了 2014 年至 2015 年在丹麦接受治疗的 644 例 LA-NSCLC 患者。基线患者特征源自丹麦肺癌登记处。放射治疗计划 CT 扫描用于手动 CACs 测量，患者分为 CACs 0、1-99、100-399 和≥400 四个组。利用 Bootstrap 进行交叉验证的多变量 Cox 模型对总生存期（OS）进行建模。
中位随访时间为 7 年，中位 OS 为 26 个月（95%CI 24-29）。在每个 CAC 组 0、1-99、100-399 和≥400 中，分别有 172、182、143 和 147 名患者。在单变量分析中，随着 CACs 的增加，生存率下降。然而，在校正年龄、PS、放射剂量和对数 GTV 后，CACs 对 OS 没有统计学意义的影响，CACs 1-99、100-399 和≥400 的危险比分别为 1.04（95%CI 0.85-1.28）、1.11（95%CI 0.89-1.43）和 1.16（95%CI 0.92-1.47）。73%的患者存在 CACs 升高，提示放射治疗前存在较高的心脏合并症风险。
CACs 并未为我们人群的经典危险因素（如肿瘤体积、表现状态和年龄）提供预后信息；尽管存在基线心脏合并症风险，但肺癌的优先级最高。
