Association between interstitial lung abnormality and mortality in patients with esophageal cancer

Akinori Hata; Masahiro Yanagawa; Tomo Miyata; Yu Hiraoka; Motohiro Shirae; Keisuke Ninomiya; Shuhei Doi; Kazuki Yamagata; Yuriko Yoshida; Noriko Kikuchi; Ryo Ogawa; Hiroto Hatabu; Noriyuki Tomiyama

doi:10.1007/s11604-024-01563-x

Association between interstitial lung abnormality and mortality in patients with esophageal cancer

Jpn J Radiol. 2024 Apr 25. doi: 10.1007/s11604-024-01563-x. Online ahead of print.

Authors

Affiliations

¹ Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan. a-hata@radiol.med.osaka-u.ac.jp.
² Department of Diagnostic and Interventional Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
³ Department of Radiology, Sakai City Medical Center, 1-1-1 Ebaraji-cho, Nishi-ku, Sakai, Osaka, 5938304, Japan.
⁴ Future Diagnostic Radiology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, 5650871, Japan.
⁵ Center for Pulmonary Functional Imaging, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.

PMID: 38658500
DOI: 10.1007/s11604-024-01563-x

Abstract

Purpose: To investigate the relationship between interstitial lung abnormalities (ILAs) and mortality in patients with esophageal cancer and the cause of mortality.

Materials and methods: This retrospective study investigated patients with esophageal cancer from January 2011 to December 2015. ILAs were visually scored on baseline CT using a 3-point scale (0 = non-ILA, 1 = indeterminate for ILA, and 2 = ILA). ILAs were classified into subcategories of non-subpleural, subpleural non-fibrotic, and subpleural fibrotic. Five-year overall survival (OS) was compared between patients with and without ILAs using the multivariable Cox proportional hazards model. Subgroup analyses were performed based on cancer stage and ILA subcategories. The prevalences of treatment complications and death due to esophageal cancer and pneumonia/respiratory failure were analyzed using Fisher's exact test.

Results: A total of 478 patients with esophageal cancer (age, 66.8 years ± 8.6 [standard deviation]; 64 women) were evaluated in this study. Among them, 267 patients showed no ILAs, 125 patients were indeterminate for ILAs, and 86 patients showed ILAs. ILAs were a significant factor for shorter OS (hazard ratio [HR] = 1.68, 95% confidence interval [CI] 1.10-2.55, P = 0.016) in the multivariable Cox proportional hazards model adjusting for age, sex, smoking history, clinical stage, and histology. On subgroup analysis using patients with clinical stage IVB, the presence of ILAs was a significant factor (HR = 3.78, 95% CI 1.67-8.54, P = 0.001). Subpleural fibrotic ILAs were significantly associated with shorter OS (HR = 2.22, 95% CI 1.25-3.93, P = 0.006). There was no significant difference in treatment complications. Patients with ILAs showed a higher prevalence of death due to pneumonia/respiratory failure than those without ILAs (non-ILA, 2/95 [2%]; ILA, 5/39 [13%]; P = 0.022). The prevalence of death due to esophageal cancer was similar in patients with and without ILA (non-ILA, 82/95 [86%]; ILA 32/39 [82%]; P = 0.596).

Conclusion: ILAs were significantly associated with shorter survival in patients with esophageal cancer.

Keywords: Chest; Computed tomography; Esophageal cancer; Interstitial lung abnormalities; Interstitial lung disease; X-ray.

Grants and funding

23K14837/Kaken Pharmaceutical