Decreased cardiovascular mortality in the ITALUNG lung cancer screening trial: Analysis of underlying factors

被引：0

作者：

Puliti, Donella ^{[1
]}

Mascalchi, Mario ^{[2
]}

Carozzi, Francesca Maria ^{[3
]}

Carrozzi, Laura ^{[4
,5
]}

Falaschi, Fabio ^{[6
]}

Paci, Eugenio ^{[1
]}

Pegna, Andrea Lopes ^{[7
]}

Aquilini, Ferruccio ^{[4
]}

Barchielli, Alessandro ^{[1
,19
]}

Bartolucci, Maurizio ^{[8
]}

Grazzini, Michela ^{[9
,14
]}

Picozzi, Giulia ^{[10
]}

Pistelli, Francesco ^{[4
]}

Rosselli, Alessandro ^{[11
]}

Zappa, Marco ^{[1
]}

Maddau, Cristina ^{[3
]}

Bisanzi, Simonetta ^{[3
]}

Manneschi, Gianfranco ^{[1
]}

Ventura, Leonardo ^{[1
]}

Visioli, Carmen ^{[1
]}

Cordopatri, Giovanna ^{[1
]}

Ocello, Cristina ^{[1
]}

Martini, Adrea ^{[10
]}

Bianchi, Roberto ^{[7
]}

Ronchi, Cristina ^{[7
]}

Crisci, Elena ^{[8
]}

De Francisci, Agostino ^{[8
]}

Falchini, Massimo ^{[8
]}

Gabbrielli, Silvia ^{[8
]}

Roselli, Giuliana ^{[8
]}

Masi, Andrea ^{[8
]}

Comin, Camilla ^{[12
]}

Vaggelli, Luca ^{[13
]}

Janni, Alberto ^{[14
]}

Cini, Stella ^{[4
]}

De Santis, Mariella ^{[4
]}

Baliva, Filomena ^{[4
]}

Chella, Antonio ^{[4
]}

Tavanti, Laura ^{[4
]}

Battola, Luigi ^{[6
]}

De Liperi, Annalisa ^{[6
]}

Spinelli, Cheti ^{[6
]}

Mussi, Alfredo ^{[15
]}

Lucchi, Marco ^{[15
]}

Fontanini, Gabriella ^{[16
]}

Tognetti, Adele Renza ^{[16
]}

Innocenti, Florio ^{[9
]}

Natali, Ilaria ^{[9
]}

Vannucchi, Letizia ^{[17
]}

Petruzzelli, Alessia ^{[17
]}

机构：

[1] ISPRO Oncol Network, Clin Epidemiol Unit, Prevent & Res Inst, Via Cosimo il Vecchio 2, I-50139 Florence, Italy

[2] Univ Florence, Dept Expt & Clin Biomed Sci Mario Serio, Florence, Italy

[3] ISPRO Oncol Network, Reg Prevent Lab Unit, Prevent & Res Inst, Florence, Italy

[4] Univ Hosp Pisa, Cardiothorac & Vasc Dept, Pisa, Italy

[5] Univ Pisa, Dept Surg Med Mol Pathol & Crit Area, Pisa, Italy

[6] Univ Hosp Pisa, Radiol Dept, Pisa, Italy

[7] Careggi Hosp, Pneumonol Dept, Florence, Italy

[8] Careggi Hosp, Radiol Dept, Florence, Italy

[9] Hosp Pistoia, Pneumonol Dept, Pistoia, Italy

[10] ISPRO Oncol Network, Radiodiagnost Unit, Prevent & Res Inst, Florence, Italy

[11] Tuscan Reg Hlth Agcy, Florence, Italy

[12] Univ Florence, Careggi Hosp, Pathol Dept, Florence, Italy

[13] Careggi Hosp, Nucl Med Dept, Florence, Italy

[14] Careggi Hosp, Thorac Surg Dept, Florence, Italy

[15] Univ Hosp Pisa, Cardiothorac & Vasc Dept, Thorac Surg Unit, Pisa, Italy

[16] Univ Hosp Pisa, Pathol Dept, Pisa, Italy

[17] Hosp Pistoia, Radiol Dept, Pistoia, Italy

[18] Le Scotte Univ Hosp, Nucl Med Dept, Siena, Italy

[19] ISPRO Oncol Network, Prevent & Res Inst, Tuscany Canc Registry, Florence, Italy

[20] Local Hlth Unit Modena, Epidemiol Unit, Modena, Italy

来源：

LUNG CANCER | 2019年 / 138卷

关键词：

Lung cancer screening; Cardiovascular mortality; Coronary arteries calcifications; CORONARY-ARTERY CALCIFICATION; COMPUTED-TOMOGRAPHY; CT; CALCIUM; EVENTS; DESIGN; DEATH; CHEST; RISK;

D O I：

10.1016/j.1ungcan.2019.10.006

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Objectives: In the ITALUNG lung cancer screening trial after 9.3 years of follow-up we observed an unexpected significant decrease of cardiovascular (CV) mortality in subjects invited for low-dose CT (LDCT) screening as compared to controls undergoing usual care. Herein we extended the mortality follow-up and analyzed the potential factors underlying such a decrease. Materials and methods: The following factors were assessed in screenes and controls: burden of CV disease at baseline, changes in smoking habits, use of CV drugs and frequency of planned vascular procedures after randomisation. Moreover, in the screenes we evaluated inclusion of presence of coronary artery calcification (CAC) in the LDCT report form that was transmitted to the participant and his/her General Practitioner. Results: The 2-years extension of follow-up confirmed a significant decrease of CV mortality in the subjects of the active group compared to control subjects (15.6 vs 34.0 per 10,000; p = 0.001) that was not observed in the drops-out of the active group. None of the explaining factors we considered significantly differed between active and control group. However, the subjects of the active group with reported CAC experienced a not significantly lower CV mortality and showed a significantly higher use of CV drugs and frequency of planned vascular procedures than the control group. Conclusions: LDCT screening for lung cancer offers the opportunity for detection of CAC that is an important CV risk factor. Although the underlying mechanisms are not clear, our results suggest that the inclusion of information about CAC presence in the LDCT report may represent a candidate factor to explain the decreased CV mortality observed in screened subjects of the ITALUNG trial, possibly resulting in intervention for patient care to prevent CV deaths. Further studies investigating whether prospective reporting and rating of CAC have independent impact on such interventions and CV mortality are worthy.

引用

页码：72 / 78

页数：7

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