Combined Impact of Coronary Artery Calcification and Heart Radiation Dose on Overall Survival in Locally Advanced Non-Small Cell Lung Cancer: Who Benefits Most from Reducing Heart Radiation Dose?
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Abstract
Background: Despite advances in treatment for unresectable locally advanced non-small cell lung cancer (LA-NSCLC), overall survival (OS) remains poor. The effects of coronary artery calcification (CAC) and heart radiation doses on OS in LA-NSCLC patients, especially their combined impact, have not been thoroughly investigated. This study aimed to examine the individual and combined effects of CAC and heart dose on OS in LA-NSCLC patients treated with radiotherapy over a 3-year follow-up period.
Patients and methods: The study included 140 patients who received definitive radiotherapy for LA-NSCLC (stage III, 92.1%) from 2015 to 2021. The endpoint was OS, with each patient followed for a fixed 3-year period.
Results: Univariate Cox regression analysis identified mean heart dose (MHD; hazard ratio [HR], 4.0 [2.2-7.3]; P < .001) and CAC in multiple vessels (HR, 2.6 [1.5-4.8]; P = .001) as significant predictors of worse OS, both serving as independent predictors of poorer outcomes in multivariate analysis. Kaplan-Meier analysis revealed that combining MHD and CAC in any coronary artery, each specific artery, and multivessels provided enhanced risk stratification for OS (P < .001 for all combinations). Among patients with higher MHD, those with calcification in the left main trunk (LMT) had the highest annual event rate (28.2%), showing a significant difference (P < .001) compared to patients with lower MHD (4.4%).
Conclusion: Combination of CAC and heart dose enhanced risk stratification for 3-year OS in LA-NSCLC patients treated with radiotherapy. Importantly, patients with calcification in the LMT derived the greatest benefit from reducing heart doses.
期刊介绍：
Clinical Lung Cancer is a peer-reviewed bimonthly journal that publishes original articles describing various aspects of clinical and translational research of lung cancer. Clinical Lung Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of lung cancer. The main emphasis is on recent scientific developments in all areas related to lung cancer. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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