Abstract
BackgroundInterstitial lung abnormalities (ILA) can be detected on computed tomography (CT) in lung cancer patients and have an association with mortality in advanced non-small cell lung cancer (NSCLC) patients. The aim of this study is to demonstrate the significance of ILA for mortality in patients with stage I NSCLC using Boston Lung Cancer Study cohort.MethodsTwo hundred and thirty-one patients with stage I NSCLC from 2000 to 2011 were investigated in this retrospective study (median age, 69 years; 93 males, 138 females). ILA was scored on baseline CT scans prior to treatment using a 3-point scale (0 = no evidence of ILA, 1 = equivocal for ILA, 2 = ILA) by a sequential reading method. ILA score 2 was considered the presence of ILA. The difference of overall survival (OS) for patients with different ILA scores were tested via log-rank test and multivariate Cox proportional hazards models were used to estimate hazard ratios (HRs) including ILA score, age, sex, smoking status, and treatment as the confounding variables.ResultsILA was present in 22 out of 231 patients (9.5%) with stage I NSCLC. The presence of ILA was associated with shorter OS (patients with ILA score 2, median 3.85 years [95% confidence interval (CI): 3.36 – not reached (NR)]; patients with ILA score 0 or 1, median 10.16 years [95%CI: 8.65 - NR]; P < 0.0001). In a Cox proportional hazards model, the presence of ILA remained significant for increased risk for death (HR = 2.88, P = 0.005) after adjusting for age, sex, smoking and treatment.ConclusionsILA was detected on CT in 9.5% of patients with stage I NSCLC. The presence of ILA was significantly associated with a shorter OS and could be an imaging marker of shorter survival in stage I NSCLC.
Highlights
Interstitial lung abnormalities (ILA) can be detected on computed tomography (CT) in lung cancer patients and have an association with mortality in advanced non-small cell lung cancer (NSCLC) patients
We have a very unique opportunity to study chest CT scans from The Boston Lung Cancer Study (BLCS; principal investigator [PI]: David C Christiani), which is a cancer epidemiology cohort of 11,164 lung cancer cases enrolled at Massachusetts General Hospital (MGH) and Dana-Farber Cancer Institute (DFCI) since 1992 with detailed demographic, smoking, occupational, and dietary information, in addition to pathology, imaging, treatments, oncogenic mutation status, and bio-samples, which have been funded by National Institute of Health
Boston lung Cancer study (BLCS) The Boston Lung Cancer Study (BLCS), PI: David C Christiani, is a cancer epidemiology cohort of 11,164 lung cancer cases enrolled at MGH and DFCI since 1992
Summary
Interstitial lung abnormalities (ILA) can be detected on computed tomography (CT) in lung cancer patients and have an association with mortality in advanced non-small cell lung cancer (NSCLC) patients. The aim of this study is to demonstrate the significance of ILA for mortality in patients with stage I NSCLC using Boston Lung Cancer Study cohort. ILA is defined as radiologic patterns of increased lung density including non-dependent ground-glass or reticular abnormalities, diffuse centrilobular nodularity, non-emphysematous cysts, honeycombing, and traction bronchiectasis affecting more than 5% of any lung zone on chest computed tomography (CT) [8]. Previous reports revealed that ILA is associated with increased respiratory symptoms, reductions of lung volume, exercise capacity, and gas exchange, and a greater risk of allcause mortality [4, 5, 11, 13, 14]. ILA is relatively common, in older individuals, but its presence is not routinely recorded on radiology reports, even at academic centres [2]
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