Coronary artery calcification is not associated with survival in advanced gastric and gastroesophageal junction cancer: a secondary analysis of the EXPAND trial

Purpose Computed tomography (CT) is the clinical standard for staging of gastrointestinal cancer. Previous studies have highlighted the prognostic significance of coronary artery calcification (CAC) detected by CT in various types of cancer. However, the prognostic role of CAC scoring in gastrointestinal cancers is still unclear. The aim of this study was to investigate the impact of CT-defined CAC on overall survival (OS) in patients with advanced gastric or gastroesophageal junction cancer. Methods CAC was semiquantitatively measured using the visual Weston method on baseline CT scans in 785 patients with unresectable locally advanced or metastatic gastric or gastroesophageal junction cancer from the phase III EXPAND trial. This present study is a secondary analysis of the base line CT images. In the original analysis patients were randomly assigned to first-line treatment with cisplatin/capecitabin ± cetuximab. The primary endpoint of the current subanalysis is the OS. For statistical analysis group differences were calculated using the Mann-Whitney-U test and ANOVA test. Kaplan-Meier curves and multivariable Cox regression analysis were used to test the effect of CAC on mortality. Results The median CAC score was 1 (IQR 0; 3). A total of 337 patients (42.9%) had no visible CAC (CAC score 0). Male patients had statistically significant higher CAC score compared to female patients (median 1 versus 0, p < 0.0001). In univariable Cox regression CAC showed no significant association with survival when analysed as a continuous value (HR: 0.99, 95% CI: 0.96–1.02, p = 0.74), and when dichotomized for absence and presence of calcification (HR:1.08, 95% CI: 0.92–1.26, p = 0.34). Similar results were identified in further subgroup analyses. Conclusion CT-defined CAC scoring has no relevant prognostic impact in advanced gastric and gastroesophageal junction cancer undergoing first-line chemotherapy. The present study cannot confirm the promising results for CAC scoring in lung cancer patients.