The prognostic effect of coronary artery calcification in locally advanced non-small cell lung cancer: An independent prognostic factor after adjustment for clinical and dosimetric variables

The Royal College of Radiologists Open Pub Date : 2025-01-01 DOI:10.1016/j.rcro.2025.100352

Yui Watanabe , Yutaro Koide , Takahiro Aoyama , Shingo Hashimoto , Hiroyuki Tachibana , Takeshi Kodaira

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Abstract

Introduction

Although several studies have reported the prognostic significance of coronary artery calcification (CAC) for overall survival (OS) in patients with locally advanced non-small cell lung cancer (LA-NSCLC), the number of cohorts focusing on patients treated with definitive radiotherapy is limited, and the role of CAC as an independent predictor of OS remains underexplored. This study aimed to evaluate the independent prognostic value of CAC for OS in patients with LA-NSCLC undergoing definitive radiotherapy by incorporating this variable into a prognostic model.

Material and methods

This study enrolled 140 patients with LA-NSCLC (stage III, 92.1 %) who underwent definitive radiotherapy between 2015 and 2021. The primary endpoint was OS, assessed over a fixed three-year follow-up period. We analyzed the relationships between patient characteristics, CAC, and radiation doses to critical organs. Prognostic models using a simple scoring for predicting OS were developed, and their predictive performance was evaluated.

Results

Univariate Cox regression revealed that CAC in multiple vessels (HR, 2.6 [1.5–4.8]; p = 0.001), elevated mean heart dose (MHD; hazard ratio [HR], 4.0 [2.2–7.3]; p < 0.001), and higher total Lung V20 (HR, 2.8 [1.5–5.5]; p = 0.002) were significantly associated with decreased OS. These factors remained independently significant in multivariate analysis: the number of vessels with CAC (p = 0.023), MHD (p = 0.046), and total Lung V20 (p = 0.027). Kaplan-Meier survival analysis demonstrated that simple scoring models based on total Lung V20, MHD and CAC provided enhanced risk stratification for OS (p < 0.001).

Conclusions

We identified CAC as an independent prognostic factor for OS in patients with LA-NSCLC undergoing definitive radiotherapy. Furthermore, a simple scoring model incorporating CAC, MHD, and total Lung V20 provided improved risk stratification for OS.

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局部晚期非小细胞肺癌冠状动脉钙化对预后的影响：调整临床和剂量变量后的独立预后因素

虽然有几项研究报道了冠状动脉钙化（CAC）对局部晚期非小细胞肺癌（LA-NSCLC）患者总生存期（OS）的预后意义，但集中于接受明确放疗的患者的队列数量有限，CAC作为OS的独立预测因子的作用仍未得到充分探讨。本研究旨在通过将CAC变量纳入预后模型，评估在接受明确放疗的LA-NSCLC患者中，CAC对OS的独立预后价值。材料和方法本研究纳入了140例LA-NSCLC （III期，92.1%）患者，这些患者在2015年至2021年间接受了最终放疗。主要终点是OS，在固定的三年随访期内进行评估。我们分析了患者特征、CAC和关键器官辐射剂量之间的关系。使用简单评分预测OS的预后模型被开发出来，并对其预测性能进行评估。结果单因素Cox回归显示，多血管CAC （HR, 2.6 [1.5-4.8]; p = 0.001）、平均心脏剂量升高（MHD， HR, 4.0 [2.2-7.3]; p < 0.001）和总肺V20升高（HR, 2.8 [1.5-5.5]; p = 0.002）与OS降低显著相关。这些因素在多变量分析中保持独立显著性：CAC血管数（p = 0.023）、MHD （p = 0.046）和总肺V20 （p = 0.027）。Kaplan-Meier生存分析表明，基于总肺V20、MHD和CAC的简单评分模型可以增强OS的风险分层（p < 0.001）。结论：我们确定CAC是接受最终放疗的LA-NSCLC患者OS的独立预后因素。此外，结合CAC、MHD和总肺V20的简单评分模型为OS提供了更好的风险分层。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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The Royal College of Radiologists Open

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