WCLC 2025 - Posters & ePosters-EP.04.13 Emphysema on Baseline CT Predicts Copd and Cardiovascular Death After 25 Years in Lung Cancer Screening

EP.04.13 Emphysema on Baseline CT Predicts Copd and Cardiovascular Death After 25 Years in Lung Cancer Screening

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A prospective cohort study of 9,047 asymptomatic adults aged 40–85 with a smoking history undergoing baseline low-dose chest CT (LDCT) for lung cancer screening between 2000 and 2008 assessed whether visual emphysema scoring predicts long-term mortality outcomes. Emphysema was visually graded from 0 (none) to 3 (severe) by expert radiologists. Over a median follow-up of 23.3 years, 29.1% of participants showed emphysema: 21.1% mild, 5.7% moderate, and 2.4% severe.<br /><br />Survival analysis revealed significant differences based on emphysema severity. All-cause survival declined with increasing emphysema: 62.5% survival in those without emphysema, versus only 28% in severe cases (p<0.0001). Similarly, COPD-specific survival dropped from 97.7% (none) to 70.3% (severe), and cardiovascular disease (CVD)-specific survival decreased modestly with emphysema severity (85.8% to 79.1%). Adjusted hazard ratios controlling for sex, age, smoking pack-years, and time since quitting indicated emphysema presence was significantly associated with higher risk of death: 29% increased all-cause mortality risk (HR 1.29, p<0.001), more than threefold increased COPD mortality risk (HR 3.29, p<0.001), and a modestly increased CVD mortality risk (HR 1.14, p=0.04).<br /><br />This study demonstrates that a single baseline visual emphysema score on LDCT in smokers enrolled in lung cancer screening predicts mortality outcomes over 25 years, particularly for COPD and CVD. Incorporating emphysema assessment in lung screening programs may identify individuals at elevated risk for multiple diseases and mortality beyond lung cancer, underscoring its value as a prognostic biomarker in clinical practice.

Asset Subtitle

Jessica González

Meta Tag

Speaker Jessica González

Topic Screening and Early Detection

Keywords

prospective cohort study

asymptomatic adults

low-dose chest CT

lung cancer screening

visual emphysema scoring

long-term mortality

COPD mortality

cardiovascular disease mortality

hazard ratio

prognostic biomarker