Interstitial Lung Abnormalities in Patients with Locally Advanced Esophageal Cancer: Prevalence, Risk Factors, and Clinical Implications

Abstract

Purpose: Interstitial lung abnormalities (ILA) represent nondependent abnormalities on chest CT indicating lung parenchymal damages due to inflammation and fibrosis. ILA has been studied as a predictor of clinical outcome in lung cancer, but not in other thoracic malignancies. The present study investigated the prevalence of ILA in patients with esophageal cancer, and identified risk factors and clinical implications of ILA in these patients.

Methods: The study included 208 patients with locally advanced esophageal cancer (median age, 65.6 years; 166 males, 42 females). ILA was scored on baseline CT scans prior to treatment using a 3-point scale (0=no evidence of ILA, 1=equivocal for ILA, 2=ILA). Clinical characteristics and overall survival were compared in patients with ILA (score 2) and others.

Results: ILA was present in 14 out of 208 patients (7%) with esophageal cancer on pre-treatment chest CT. Patients with ILA were significantly older (median age: 69 vs. 65, respectively; p=0.011), had a higher number of pack-years of smoking (p=0.02), and more commonly had T4 stage disease (p=0.026) than patients with ILA score of 1 or 0. ILA on baseline scan was associated with a lack of surgical resection after chemoradiotherapy (7/14, 50% vs. 39/194, 20% respectively; p=0.016). ILA was not associated with OS (log-rank p=0.75, Cox p=0.613).

Conclusion: Radiographic ILA was present in 7% of esophageal cancer patients, and was strongly associated with a lack of surgical resection after chemoradiotherapy, indicating an implication of ILA in treatment selection in these patients, which can be further studied in larger cohorts.

Note:
Funding Information: MN was supported by R01CA203636, U01CA209414, R01HL111024, and R01CA240592.

Declaration of Interests: Tseng, Hino, Lin, Park, Sanford: Nothing to disclose. Hatabu: Research funding from Canon Inc., Canon Medical Systems, and Konica-Minolta; Consultant to Canon Medical Systems, and Mitsubishi Chemical Inc. Nishino: Consultant to Daiichi Sankyo, AstraZeneca; Research grant from Merck, Canon Medical Systems, AstraZeneca, Daiichi Sankyo. Mamon: Consulting for Merck, Royalties from UpToDate.

Ethical Approval Statement: Clinical record of the patients including demographics, clinical characteristics and outcome as well as CT studies were retrospectively reviewed under the institutional review board approval with the waiver of the informed consent.

Keywords: Interstitial lung abnormalities (ILA), computed tomography, esophageal cancer, chemoradiotherapy, chest radiology