Ahn Yura, Lee Sang Min, Choe Jooae, Noh Han Na, Park Sung-Won, Jung Young Ju, Kim Sehee, Seo Joon Beom
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Health Screening and Promotion Center, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
Eur Radiol. 2025 Jul 26. doi: 10.1007/s00330-025-11874-w.
To evaluate the effect of CT progression of interstitial lung abnormality (ILA) and ILA subtypes on pulmonary function and mortality in lung cancer screening (LCS) participants with preserved pulmonary function.
Consecutive participants who met the 2021 United States Preventive Services Task Force guidelines for LCS during a medical check-up between 2012 and 2014 were retrospectively analyzed. Forced vital capacity (FVC) ≥ 80% at baseline was considered indicative of preserved pulmonary function. CT progression and ILA subtype were evaluated for their association with an FVC decline to < 80% and mortality using multivariable time-dependent Cox analysis.
Among the 6332 LCS participants, 133 with baseline FVC ≥ 80% and follow-up CT and FVC data were included. CT progression was observed in 81.8% (54/66) of those with ILA and 67.2% (45/67) of those with equivocal ILA, with median follow-ups of 61.0 and 76.0 months, respectively. FVC decline to < 80% occurred in 21.1% (28/133) with a median time of 61.4 months. It was associated only with baseline FVC (hazard ratio (HR), 0.78; p < 0.001), while CT progression (p = 0.720) and fibrotic ILA (p = 0.066) were not. For mortality, both CT progression (HR, 8.74; p < 0.001) and a relative FVC decline ≥ 10% (HR, 10.30; p < 0.001) were independent risk factors, whereas fibrotic ILA was not (p = 0.254).
CT progression was a risk factor for mortality, although it was not associated with a decline in FVC to below 80% in participants with preserved lung function. Monitoring CT progression in LCS would be helpful for risk stratification of participants with ILA.
Question Does interstitial lung abnormality (ILA) CT progression affect pulmonary function decline and mortality, even when pulmonary function is preserved? Findings When pulmonary function was preserved, CT progression was not associated with forced vital capacity decline but was an independent risk factor for mortality. Clinical relevance Monitoring CT progression during lung cancer screening adherence could aid in risk stratification for participants with ILA.
评估间质性肺异常（ILA）的CT进展及ILA亚型对肺功能正常的肺癌筛查（LCS）参与者的肺功能和死亡率的影响。
回顾性分析2012年至2014年体检期间符合2021年美国预防服务工作组LCS指南的连续参与者。基线时用力肺活量（FVC）≥80%被认为肺功能正常。使用多变量时间依赖性Cox分析评估CT进展和ILA亚型与FVC下降至<80%及死亡率的关联。
在6332名LCS参与者中，纳入了133名基线FVC≥80%且有随访CT和FVC数据的参与者。ILA患者中81.8%（54/66）出现CT进展，ILA不明确患者中67.2%（45/67）出现CT进展，中位随访时间分别为61.0个月和76.0个月。FVC下降至<80%发生在21.1%（28/133）的参与者中，中位时间为61.4个月。它仅与基线FVC相关（风险比[HR]，0.78；p<0.001），而CT进展（p=0.720）和纤维化ILA（p=0.066）与之无关。对于死亡率，CT进展（HR，8.74；p<0.001）和FVC相对下降≥10%（HR，10.30；p<0.001）均为独立危险因素，而纤维化ILA不是（p=0.254）。
CT进展是死亡率的危险因素，尽管在肺功能正常的参与者中它与FVC下降至80%以下无关。监测LCS中的CT进展将有助于ILA参与者的风险分层。
问题即使肺功能正常，间质性肺异常（ILA）的CT进展是否会影响肺功能下降和死亡率？研究结果当肺功能正常时，CT进展与用力肺活量下降无关，但却是死亡率的独立危险因素。临床意义在肺癌筛查依从性期间监测CT进展有助于ILA参与者的风险分层。
