Multifactorial Analysis of Mortality in Screening Detected Lung Cancer

Abstract

We hypothesized that severity of coronary artery calcification (CAC), emphysema, muscle mass, and fat attenuation can help predict mortality in patients with lung cancer participating in the National Lung Screening Trial (NLST). Following regulatory approval from the Cancer Data Access System (CDAS), all patients diagnosed with lung cancer at the time of the screening study were identified. These subjects were classified into two groups: survivors and nonsurvivors at the conclusion of the NLST trial. These groups were matched based on their age, gender, body mass index (BMI), smoking history, lung cancer stage, and survival time. CAC, emphysema, muscle mass, and subcutaneous fat attenuation were quantified on baseline low-dose chest CT (LDCT) for all patients in both groups. Nonsurvivor group had significantly greater CAC, decreased muscle mass, and higher fat attenuation compared to the survivor group (p < 0.01). No significant difference in severity of emphysema was noted between the two groups (p > 0.1). We thus conclude that it is possible to create a quantitative prediction model for lung cancer mortality for subjects with lung cancer detected on screening low-dose CT (LDCT).

Figure 1

Method used to select patients for study.

Figure 2

Examples of none, mild, moderate, and severe CAC (0, 1, 2, and 3). The display interval is [40,400].

Figure 3

The process used to measure skeletal muscle area (pectoralis major). The display interval is [40,400].

Figure 4

The process used to measure fat attenuation. The display interval is [40,400].