Key result
In patients with LA-NSCLC post-radiotherapy, a high-risk CHyLL score (≥5) was associated with a higher 48-month MACE incidence compared to a low-risk score (23.6% vs 6.8%, p=0.041).
Why the study?
Mean heart dose and LADV15 are associated with MACE in patients with LA-NSCLC post-radiotherapy, prompting the development of a MACE prediction model in this population.
Does the CHyLL risk prediction model accurately predict major adverse cardiac events in patients with locally advanced non-small cell lung cancer post-radiotherapy?
Cohort (n=701)
Does the CHyLL risk prediction model accurately predict major adverse cardiac events in patients with locally advanced non-small cell lung cancer post-radiotherapy?
Absolute Event Rate: 23.6% vs 6.8%
p-value: p=0.041
The CHyLL risk prediction model effectively predicts major adverse cardiac events in lung cancer patients post-radiotherapy and can be used to estimate personalized radiation dose constraints.
BACKGROUND AND PURPOSE: In patients with locally advanced non-small cell lung cancer (LA-NSCLC) post-radiotherapy, mean heart dose (MHD) and the percent of left anterior descending (LAD) coronary artery receiving ≥15 Gy (LADV15) are associated with major adverse cardiac events (MACE). We developed a MACE prediction model in this population. MATERIALS AND METHODS: Total 701 patients with LA-NSCLC treated with curative-intent radiotherapy reviewed, split by diagnosis date into "development" (n = 500) and later (n = 201) "test" cohorts. Development patients were analyzed using a multivariable Cox-proportional hazard model with backward elimination scheme (Bonferroni-adjusted α = 0.025). Potential predictors were selected a priori: age, coronary heart disease (CHD), Framingham Risk, hypertension, MHD, LADV15, intensity modulated radiotherapy use, and CHD and LADV15 interaction (CHD:LADV15). Cardiac doses as quadratic, square root, and logarithmic (ln[X + 1]) forms were explored. Models were internally validated with bootstrapping. RESULTS: Final model incorporated CHD, Hypertension, Logarithmic LADV15, and CHD*ln[LADV15 + 1] (CHyLL; β coefficients: 5.51, 1.28, 1.48, -1.36; all p < 0.025; bootstrapping c-index: 0.80; test cohort c-index: 0.76). Possible risk score range: 0-8.11. MACE incidence was 6.8% and 23.6% at 48 months (p = 0.041), and survival rates were 51.6% and 35.0% (p = 0.099), in the low-risk (score <5.00) and high-risk (score ≥5) test groups, respectively. Using the model, calculated LADV15 constraints for patients without CHD were 11.3% and 28.3% for those with and without hypertension, respectively, to remain low-risk. CONCLUSIONS: Pre-existing CHD, hypertension, and LADV15 were important factors in predicting MACE after radiotherapy. CHyLL has the potential to estimate personalized LADV15 constraints based on cardiac risk factors and acceptable MACE thresholds.
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Tjong et al. (2022) conducted a cohort in Locally advanced non-small cell lung cancer (LA-NSCLC) (n=701). High-risk CHyLL score (≥5) vs. Low-risk CHyLL score (<5) was evaluated on Major adverse cardiac events (MACE) at 48 months (p=0.041). In patients with LA-NSCLC post-radiotherapy, a high-risk CHyLL score (≥5) was associated with a higher 48-month MACE incidence compared to a low-risk score (23.6% vs 6.8%, p=0.041).
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