Abstract
Background and purpose: Coronary artery calcium score (CACs) is an excellent marker for survival in non-cancer patients, but its role in locally advanced non-small cell lung cancer (LA-NSCLC) patients remains uncertain. In this study, we hypothesize that CACs is a prognostic marker for survival in a competing risk analysis in LA-NSCLC patients treated with definitive radiotherapy. Materials and methods: We included 644 patients with LA-NSCLC treated in 2014-2015 in Denmark. Baseline patient characteristics were derived from the Danish Lung Cancer Registry. Radiotherapy planning CT scans were used for manual CACs measurements, and the patients were divided into four groups, CACs 0, 1-99, 100-399, and ≥400. A multivariable Cox model utilizing bootstrapping for cross-validation modeled overall survival (OS). Results: The median follow-up time was seven years, and the median OS was 26 months (95% CI 24-29). Within each CAC group 0, 1-99, 100-399, and ≥400 were 172, 182, 143, and 147 patients, respectively. In the univariable analysis, the survival decreased with increasing CACs. However, after adjustment for age, PS, radiotherapy dose, and logarithmic GTV, CACs did not have a statistically significant impact on OS with hazard ratios of 1.04 (95% CI 0.85-1.28), 1.11 (95%CI 0.89-1.43), and 1.16 (95%CI 0.92-1.47) for CACs 1-99, CACs 100-399 and ≥400, respectively. Elevated CACs was observed in 73 % of the patients suggesting a high risk of cardiac comorbidity before radiotherapy. Conclusion: CACs did not add prognostic information to our population's classical risk factors, such as tumor volume, performance status, and age; the lung cancer has the highest priority despite the risk of baseline cardiac comorbidity.
| Originalsprog | Engelsk |
|---|---|
| Artikelnummer | 109719 |
| Tidsskrift | Radiotherapy and Oncology |
| Vol/bind | 185 |
| ISSN | 0167-8140 |
| DOI | |
| Status | Udgivet - 2023 |
Bibliografisk note
Funding Information:The sources were not involved in the design, data collection, analysis, or manuscript writing. The remaining authors declare no conflict of interest. Supported by DCCC-Radiotherapy - The Danish National Research Center for Radiotherapy, Danish Cancer Society (grant no. R191-A11526), Danish Comprehensive Cancer Center, Danish Research Center for Lung Cancer, and Academy of Geriatric Cancer Research (AgeCare).
Funding Information:
The authors thank OPEN (Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark) for providing guidance and establishing a REDCap database for gathering CACs and radiotherapy dates. In addition, the authors thank Simon Long Krogh for establishing a project database and gathering DICOM files in DcmCollab. Finally, thank Professor Marianne Ewertz, Department of Clinical Research, University of Southern Denmark, for proofreading the manuscript. This work was funded by DCCC-Radiotherapy - The Danish National Research Center for Radiotherapy, Danish Cancer Society (grant no. R191-A11526), Danish Comprehensive Cancer Center, Danish Research Center for Lung Cancer, and Academy of Geriatric Cancer Research (AgeCare).
Funding Information:
The authors thank OPEN (Open Patient data Explorative Network, Odense University Hospital, Region of Southern Denmark) for providing guidance and establishing a REDCap database for gathering CACs and radiotherapy dates. In addition, the authors thank Simon Long Krogh for establishing a project database and gathering DICOM files in DcmCollab. Finally, thank Professor Marianne Ewertz, Department of Clinical Research, University of Southern Denmark, for proofreading the manuscript. This work was funded by DCCC-Radiotherapy - The Danish National Research Center for Radiotherapy, Danish Cancer Society (grant no. R191-A11526), Danish Comprehensive Cancer Center, Danish Research Center for Lung Cancer, and Academy of Geriatric Cancer Research (AgeCare).
Publisher Copyright:
© 2023 Elsevier B.V.