Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV1, and Emphysema in Lung Cancer Screening Population: The MILD Trial
Relationship and Prognostic Value of Modified Coronary Artery Calcium Score, FEV1, and Emphysema in Lung Cancer Screening Population: The MILD Trial
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DOI：
10.1148/radiol.11110364
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发表时间：
2012-02-01
期刊：
影响因子：
19.7
通讯作者：
Pastorino, Ugo
中科院分区：
文献类型：
--
作者：
Sverzellati, Nicola;Cademartiri, Filippo;Pastorino, Ugo
目的：在一项肺癌计算机断层扫描 (CT) 筛查试验中，评估改良冠状动脉钙化 (mCAC) 评分与第一秒用力呼气量 (FEV1) 和肺气肿之间的关系，以及这些因素与全因死亡率和心血管事件 (CVE) 的关联。 材料和方法：在这项机构审查委员会批准的研究中，在由美国癌症研究所连续招募的重度吸烟者队列中评估了临床和低剂量 CT 数据。多中心意大利肺部检测（MILD）试验。使用可量化 mCAC、平均肺衰减 (MLA) 和肺气肿总范围的软件对低剂量 CT 图像进行分析。使用 Pearson 相关系数测试 mCAC、预测 FEV1 百分比、MLA 和肺气肿程度之间的相关性。应用调整后的多重逻辑回归模型来评估 mCAC、FEV1、MLA 和肺气肿程度与全因死亡率和 CVE 之间的关系。 结果：最终研究队列由 1159 名吸烟者组成。 mCAC 评分与 FEV1 (r = -0.03, P = .4)、MLA (r = -0.01, P = .7) 或肺气肿程度 (r = 0.02, P = .6) 之间没有显着相关性。 mCAC 评分大于 400 是唯一与全因死亡率（比值比 [OR]：3.73；95% 置信区间 [CI]：1.05, 13.32；P = .04）和 CVE（OR：2.87；95% CI：1.13, 7.27；P = .03）独立相关的因素。结论：mCAC 是与 FEV1 和肺气肿程度相比，它是 CVE 和全因死亡率更好的预测因子，并且可能有助于在肺癌筛查环境中识别高风险个体。
Purpose: To assess the relationship between a modified coronary artery calcium (mCAC) score and both forced expiratory volume in 1 second (FEV1) and pulmonary emphysema and the associations of such factors with all-cause mortality and cardiovascular events (CVEs) in a lung cancer computed tomographic (CT) screening trial.Materials and Methods: In this institutional review board-approved study, both clinical and low-dose CT data were evaluated in a cohort of heavy smokers consecutively recruited by the Multicentric Italian Lung Detection, or MILD, trial. Low-dose CT images were analyzed by using software that allowed quantification of mCAC, mean lung attenuation (MLA), and total extent of emphysema. The correlations between mCAC, percentage predicted FEV1, MLA, and emphysema extent were tested by using the Pearson correlation coefficient. Adjusted multiple logistic regression models were applied to assess the relationships between mCAC, FEV1, MLA, and emphysema extent and all-cause mortality and CVEs.Results: The final study cohort consisted of 1159 smokers. There were no significant correlations between mCAC score and FEV1 (r = -0.03, P = .4), MLA (r = -0.01, P = .7), or emphysema extent (r = 0.02, P = .6). An mCAC score greater than 400 was the only factor that was independently associated with both all-cause mortality (odds ratio [OR]: 3.73; 95% confidence interval [CI]: 1.05, 13.32; P = .04) and CVEs (OR: 2.87; 95% CI: 1.13, 7.27; P = .03).Conclusion: mCAC is a better predictor of CVE and all-cause mortality than FEV1 and emphysema extent and may contribute to the identification of high-risk individuals in a lung cancer screening setting.