CT-defined coronary artery calcification as a prognostic marker for overall survival in lung cancer : a systematic review and meta-analysis

Rationale and Objectives: Coronary artery calcification (CAC) can be quantified by computed tomography (CT). It is an important predictive and prognostic imaging marker for cardiovascular disease. The prognostic role for CAC in oncological patients is provided in preliminary studies, especially in lung cancer patients. The aim of the present study was to establish the effect of CAC score on overall survival (OS) in lung cancer patients based on the published literature. Materials and Methods: Literature databases were screened for papers analyzing the association between CAC and overall survival in lung cancer patients up to June 2024. The primary endpoint of the present systematic review was the OS. Overall, seven studies were suitable for the analysis and were included. Results: The included studies comprised 2292 patients undergoing curative treatment. The pooled hazard ratio for the association between CAC score and OS was HR = 1.42 (95% CI = (1.19; 1.69), p < 0.0001) in the univariable analysis and HR = 1.56 (95% CI = (1.25; 1.94), p < 0.0001) in the multivariable analysis. The pooled odds ratio for the association between CAC score and major cardiovascular events was OR = 1.97 (95% CI = (1.24; 3.13)], p = 0.004. Conclusion: CT-defined CAC has a meaningful impact on overall survival and prediction of major cardiovascular events in lung cancer patients undergoing curative treatment. The sole presence of CAC on staging CT should be reported as an important prognostic marker in these patients.