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@ARTICLE{Mascalchi:274082,
author = {M. Mascalchi$^*$ and C. Romei and C. Marzi and S. Diciotti
and G. Picozzi and F. Pistelli and M. Zappa and E. Paci and
F. Carozzi and G. Gorini and F. Falaschi and A. L. Deliperi
and G. Camiciottoli and L. Carrozzi and D. Puliti},
title = {{P}ulmonary emphysema and coronary artery calcifications at
baseline {LDCT} and long-term mortality in smokers and
former smokers of the {ITALUNG} screening trial.},
journal = {European radiology},
volume = {33},
number = {5},
issn = {0938-7994},
address = {Heidelberg},
publisher = {Springer},
reportid = {DKFZ-2023-00428},
pages = {3115-3123},
year = {2023},
note = {#EA:C020# / 2023 May;33(5):3115-3123},
abstract = {Cardiovascular disease (CVD), lung cancer (LC), and
respiratory diseases are main causes of death in smokers and
former smokers undergoing low-dose computed tomography
(LDCT) for LC screening. We assessed whether quantification
of pulmonary emphysematous changes at baseline LDCT has a
predictive value concerning long-term mortality.In this
longitudinal study, we assessed pulmonary emphysematous
changes with densitometry (volume corrected relative area
below - 950 Hounsfield units) and coronary artery
calcifications (CAC) with a 0-3 visual scale in baseline
LDCT of 524 participants in the ITALUNG trial and analyzed
their association with mortality after 13.6 years of
follow-up using conventional statistics and a machine
learning approach.Pulmonary emphysematous changes were
present in $32.3\%$ of subjects and were mild $(6\%$ ≤
RA950 ≤ $9\%)$ in $14.9\%$ and moderate-severe (RA950 >
$9\%)$ in $17.4\%.$ CAC were present in $67\%$ of subjects
(mild in $34.7\%,$ moderate-severe in $32.2\%).$ In the
follow-up, 81 $(15.4\%)$ subjects died (20 of LC, 28 of
other cancers, 15 of CVD, 4 of respiratory disease, and 14
of other conditions). After adjusting for age, sex, smoking
history, and CAC, moderate-severe emphysema was
significantly associated with overall (OR 2.22; 95CI
1.34-3.70) and CVD (OR 3.66; 95CI 1.21-11.04) mortality.
Machine learning showed that RA950 was the best single
feature predictive of overall and CVD
mortality.Moderate-severe pulmonary emphysematous changes
are an independent predictor of long-term overall and CVD
mortality in subjects participating in LC screening and
should be incorporated in the post-test calculation of the
individual mortality risk profile.• Densitometry allows
quantification of pulmonary emphysematous changes in
low-dose CT examinations for lung cancer screening. •
Emphysematous lung density changes are an independent
predictor of long-term overall and cardio-vascular disease
mortality in smokers and former smokers undergoing
screening. • Emphysematous changes quantification should
be included in the post-test calculation of the individual
mortality risk profile.},
keywords = {Cardiovascular disease (Other) / Cause of death (Other) /
Lung neoplasm (Other) / Pulmonary emphysema (Other) /
Smokers (Other)},
cin = {C020},
ddc = {610},
cid = {I:(DE-He78)C020-20160331},
pnm = {313 - Krebsrisikofaktoren und Prävention (POF4-313)},
pid = {G:(DE-HGF)POF4-313},
typ = {PUB:(DE-HGF)16},
pubmed = {pmid:36854875},
doi = {10.1007/s00330-023-09504-4},
url = {https://inrepo02.dkfz.de/record/274082},
}