Lung and pleural CT signs predict deaths: 10-year follow-up after lung cancer screening of asbestos-exposed workers

Abstract

Purpose: To work out the predictive value of pathological (HR)CT signs concerning long-term mortality among those screened for lung cancer.

Methods: Five hundred and eighty four construction workers (574 males, 10 females) were originally screened for lung cancer and found negative. Their images were also scored for several lung and pleural signs. Mortality data were checked from the National Registry of Causes of Death. Cox regression adjusted for age, sex, smoking, BMI, and asbestos exposure was used to explore the relations between the radiological signs and deaths. The mean follow-up time was 10.53 years (0.56-12.98 years) and a total of 6,150 person years were followed up.

Results: Altogether, 185 deaths occurred (64 cardiovascular, 51 cancer, 24 non-cancer respiratory deaths, and 46 deaths from other causes). All studied emphysema signs were significant predictors of all-cause deaths as were most fibrosis signs (subpleural nodules, septal lines, parenchymal bands, and honeycombing), ground-glass opacities, thickened bronchial walls, pleural plaque extent, and adherences. Cardiovascular deaths were significantly associated with paraseptal emphysema and bullae. Several lung/pleural signs also predicted cancer and respiratory deaths.

Conclusion: Pathological lung/pleural CT signs found in screening seem to predict deaths in long term, which may require more careful medical surveillance of such individuals. Further studies are needed to generalize the present findings to general population.