Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Lung Cancer. 2023 Nov;185:107387. doi: 10.1016/j.lungcan.2023.107387. Epub 2023 Oct 4.
This study explored female and male overall mortality and lung cancer (LC) survival in two LC screening (LCS) populations, focusing on the predictive value of coronary artery calcification (CAC) at baseline low-dose computed tomography (LDCT).
This retrospective study analysed data of 6495 heavy smokers enrolled in the MILD and BioMILD LCS trials between 2005 and 2016. The primary objective of the study was to assess sex differences in all-cause mortality and LC survival. CAC scores were automatically calculated on LDCT images by a validated artificial intelligence (AI) software. Sex differences in 12-year cause-specific mortality rates were stratified by age, pack-years and CAC score.
The study included 2368 females and 4127 males. The 12-year all-cause mortality rates were 4.1 % in females and 7.7 % in males (p < 0.0001), and median CAC score was 8.7 vs. 41 respectively (p < 0.0001). All-cause mortality increased with rising CAC scores (log-rank test, p < 0.0001) for both sexes. Although LC incidence was not different between the two sexes, females had lower rates of 12-year LC mortality (1.0 % vs. 1.9 %, p = 0.0052), and better LC survival from diagnosis (72.3 % vs. 51.7 %; p = 0.0005), with a similar proportion of stage I (58.1 % vs. 51.2 %, p = 0.2782).
Our findings demonstrate that female LCS participants had lower rates of all-cause mortality at 12 years and better LC survival than their male counterparts, with similar LC incidence rates and stage at diagnosis. The lower CAC burden observed in women at all ages might contribute to explain their lower rates of all-cause mortality and better LC survival.
本研究旨在探讨两种肺癌筛查（LCS）人群中女性和男性的总死亡率和肺癌（LC）生存率，重点关注基线低剂量计算机断层扫描（LDCT）时冠状动脉钙化（CAC）的预测价值。
本回顾性研究分析了 2005 年至 2016 年间纳入 MILD 和 BioMILD LCS 试验的 6495 名重度吸烟者的数据。该研究的主要目的是评估两性之间全因死亡率和 LC 生存率的差异。LDCT 图像上的 CAC 评分由经过验证的人工智能（AI）软件自动计算。按年龄、吸烟包年数和 CAC 评分对 12 年病因特异性死亡率的性别差异进行分层。
该研究纳入了 2368 名女性和 4127 名男性。女性的 12 年全因死亡率为 4.1%，男性为 7.7%（p<0.0001），中位 CAC 评分分别为 8.7 和 41（p<0.0001）。两种性别中，随着 CAC 评分的升高，全因死亡率均升高（对数秩检验，p<0.0001）。虽然两性的 LC 发病率无差异，但女性的 12 年 LC 死亡率较低（1.0%比 1.9%，p=0.0052），LC 从诊断开始的生存率较高（72.3%比 51.7%；p=0.0005），且相同比例的患者处于 I 期（58.1%比 51.2%，p=0.2782）。
我们的研究结果表明，女性 LCS 参与者在 12 年内全因死亡率较低，LC 生存率高于男性，LC 发病率和诊断时的分期相似。所有年龄段女性的 CAC 负担较低可能有助于解释其全因死亡率较低和 LC 生存率较高的原因。
