量化评估肺部纤维化进展，可预测肺癌筛查人群的死亡风险。
Association of Progressive PPFE and Mortality in Lung Cancer Screening Cohorts
- 通过自动化算法分析低剂量CT，量化肺部纤维化体积变化。
- 纤维化进展者死亡风险显著升高，最高HR达3.14。
- 适合关注肺癌筛查中呼吸系统风险的临床医生与研究者。
背景：胸膜-肺实质纤维弹性组织增生（PPFE）是一种以肺上叶为主的纤维化异常，与已确诊间质性肺病患者的死亡率增加相关。但在肺癌筛查（LCS）人群中，影像学PPFE进展的临床意义尚不明确。方法：我们分析了两项LCS研究——国家肺筛查试验（NLST，n=7,980）和SUMMIT研究（n=8,561）的纵向低剂量CT扫描与临床数据。采用自动化算法在基线与随访扫描中量化PPFE体积，计算年化变化率，并基于分布阈值分为进展组与非进展组。使用校正人口学与临床变量的Cox比例风险模型评估进展型PPFE与死亡率的关系。在SUMMIT队列中，还采用发病率比（IRR）和比值比（OR）评估其与临床结局的关联。结果：在两个队列中，进展型PPFE均独立关联死亡率（NLST：HR=1.25，95% CI: 1.01–1.56，p=0.042；SUMMIT：HR=3.14，95% CI: 1.66–5.97，p<0.001）。在SUMMIT中，进展型PPFE与更高的呼吸系统住院率（IRR=2.79，p<0.001）、抗生素与激素使用增加（IRR=1.55，p=0.010）相关，并呈现改良医学研究理事会评分升高的趋势（OR=1.40，p=0.055）。结论：影像学上PPFE的进展独立关联于死亡率，并与不良临床结局相关。对PPFE进展的定量评估可能成为肺癌筛查项目中识别高风险个体的临床影像生物标志物。
原文摘要 · Abstract (English)
Background: Pleuroparenchymal fibroelastosis (PPFE) is an upper lobe predominant fibrotic lung abnormality associated with increased mortality in established interstitial lung disease. However, the clinical significance of radiologic PPFE progression in lung cancer screening (LCS) populations remains unclear. Methods: We analysed longitudinal low-dose CT scans and clinical data from two LCS studies: National Lung Screening Trial (NLST; n=7,980); SUMMIT study (n=8,561). An automated algorithm quantified PPFE volume on baseline and follow-up scans. Annualised change in PPFE was derived and dichotomised using a distribution-based threshold to define progressive PPFE. Associations between progressive PPFE and mortality were evaluated using Cox proportional hazards models adjusted for demographic and clinical variables. In SUMMIT cohort, associations between progressive PPFE and clinical outcomes were assessed using incidence rate ratios (IRR) and odds ratios (OR). Findings: Progressive PPFE independently associated with mortality in both LCS cohorts (NLST: Hazard Ratio (HR)=1.25, 95% Confidence Interval (CI): 1.01--1.56, p=0.042; SUMMIT: HR=3.14, 95% CI: 1.66--5.97, p<0.001). Within SUMMIT, progressive PPFE was strongly associated with higher respiratory admissions (IRR=2.79, p<0.001), increased antibiotic and steroid use (IRR=1.55, p=0.010), and showed a trend towards higher modified medical research council scores (OR=1.40, p=0.055). Interpretation: Radiologic PPFE progression independently associates with mortality across two large LCS cohorts, and associates with adverse clinical outcomes. Quantitative assessment of PPFE progression may provide a clinically relevant imaging biomarker to identify individuals at increased risk of respiratory morbidity within LCS programmes.
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