冠状动脉钙化与晚期胃癌及胃食管结合部癌患者的生存无关：EXPAND 试验的二次分析。
完整摘要 · 中文译文
目的：计算机断层扫描（CT）是胃肠道肿瘤分期的临床标准。既往研究已强调，CT检测的冠状动脉钙化（CAC）在多种类型肿瘤中具有预后意义。然而，CAC评分在胃肠道肿瘤中的预后作用仍不明确。本研究旨在探讨CT定义的CAC对晚期胃癌或胃食管结合部癌患者总生存期（OS）的影响。 方法：在III期EXPAND试验中，对785例不可切除的局部晚期或转移性胃癌或胃食管结合部癌患者的基线CT扫描，采用视觉Weston法对CAC进行半定量测量。本研究是对基线CT图像的二次分析。在原始分析中，患者被随机分配接受顺铂/卡培他滨±西妥昔单抗的一线治疗。当前亚分析的主要终点是OS。统计分析中，组间差异采用Mann-Whitney-U检验和ANOVA检验计算。采用Kaplan-Meier曲线和多变量Cox回归分析检验CAC对死亡率的影响。 结果：CAC评分中位数为1（IQR 0；3）。共有337例患者（42.9%）无可见CAC（CAC评分0）。男性患者的CAC评分在统计学上显著高于女性患者（中位数1对0，p < 0.0001）。在单变量Cox回归中，当CAC作为连续值分析时，其与生存无显著相关性（HR：0.99，95% CI：0.96-1.02，p = 0.74）， 并按钙化的有无进行二分类时（HR：1.08，95% CI：0.92-1.26，p = 0.34）。在进一步的亚组分析中发现了相似的结果。 结论：CT定义的CAC评分在接受一线化疗的晚期胃癌和胃食管结合部癌中无相关预后影响。本研究无法证实CAC评分在肺癌患者中的良好结果。
完整摘要 · 英文原文
PURPOSE: Computed tomography (CT) is the clinical standard for staging of gastrointestinal cancer. Previous studies have highlighted the prognostic significance of coronary artery calcification (CAC) detected by CT in various types of cancer. However, the prognostic role of CAC scoring in gastrointestinal cancers is still unclear. The aim of this study was to investigate the impact of CT-defined CAC on overall survival (OS) in patients with advanced gastric or gastroesophageal junction cancer. METHODS: CAC was semiquantitatively measured using the visual Weston method on baseline CT scans in 785 patients with unresectable locally advanced or metastatic gastric or gastroesophageal junction cancer from the phase III EXPAND trial. This present study is a secondary analysis of the base line CT images. In the original analysis patients were randomly assigned to first-line treatment with cisplatin/capecitabin ± cetuximab. The primary endpoint of the current subanalysis is the OS. For statistical analysis group differences were calculated using the Mann-Whitney-U test and ANOVA test. Kaplan-Meier curves and multivariable Cox regression analysis were used to test the effect of CAC on mortality. RESULTS: The median CAC score was 1 (IQR 0; 3). A total of 337 patients (42.9%) had no visible CAC (CAC score 0). Male patients had statistically significant higher CAC score compared to female patients (median 1 versus 0, p < 0.0001). In univariable Cox regression CAC showed no significant association with survival when analysed as a continuous value (HR: 0.99, 95% CI: 0.96-1.02, p = 0.74), and when dichotomized for absence and presence of calcification (HR:1.08, 95% CI: 0.92-1.26, p = 0.34). Similar results were identified in further subgroup analyses. CONCLUSION: CT-defined CAC scoring has no relevant prognostic impact in advanced gastric and gastroesophageal junction cancer undergoing first-line chemotherapy. The present study cannot confirm the promising results for CAC scoring in lung cancer patients.