Predictors of survival in patients with stage I lung cancer |
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Predictors of survival in patients with stage I lung cancer
Dr Surya Kant, Professor and Head, Dept. of Respiratory Medicine, KGMU, UP, Lucknow. National Vice Chairman IMA-AMS,  05 May 2022
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#Multispeciality #Pulmonary Medicine

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Imaging features on chest CT scans such as coronary artery calcium (CAC) score, pulmonary artery (PA)-to-aorta ratio and thoracic skeletal muscle index can be used to predict overall survival after radiotherapy in patients with stage I lung cancer, according to a recent modeling study reported in the American Journal of Roentgenology (AJR).1

Researchers retrospectively analyzed the chest CT scans of 282 patients with a median age of 75 years with stage I lung cancer before they received stereotactic body radiation therapy between January 2009 and June 2017. The study group had 168 female and 114 male participants. In this study, they aimed to  examine if noncancerous features such as coronary artery calcium (CAC) scores, pulmonary artery (PA)-to-aorta ratio, emphysema, body composition and attenuation of skeletal muscle could predict overall survival and noncancer-related death after treatment.

There were 148 deaths including 83 noncancer deaths in this single center study. The median overall survival was 60.8 months. But the overall survival was shorter in patients who had higher CAC score (hazard ratio 1.83), higher PA-to-aorta ratio (HR 1.33) and lower thoracic skeletal muscle index (HR 0.88).

The predictive ability for 5-year overall survival was greater when clinical and radiological features were used together vis-à-vis use of clinical features alone; AUC 0.75 vs 0.61 respectively.

This study has shown that use of imaging features such as CAC score, PA-to-aorta ratio and thoracic skeletal muscle index can be used in conjunction with clinical features such as age, performance status as assessed by the Eastern Cooperative Oncology Group (ECOG) score and underlying comorbid conditions, improves prediction of the overall survival in patients with stage I lung cancer treated with stereotactic body radiation therapy. This will enhance patient counselling and decision making. However, the authors have called for further studies to validate the findings of their study.

Reference

  1. Tahir I, et al. Utility of noncancerous chest CT features for predicting overall survival and noncancer death in patients with stage I lung cancer treated with stereotactic body radiotherapy. AJR Am J Roentgenol. 2022 Apr 13. doi: 10.2214/AJR.22.27484.
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