Automated Measurement of Coronary Artery Calcifications and Routine Perioperative Blood Tests Predict Survival in Resected Stage I Lung Cancer

Introduction: Coronary artery calcification (CAC) is a well- known cardiovascular risk factor. In the past year, the CAC score has been investigated in lung cancer (LC) screening, suggesting promising results in terms of mortality risk assessment. Nevertheless, its role in patients with LC is still to be investigated. This study aimed to evaluate the per- formance of a fully automated CAC scoring alone and combined with a prognostic index on the basis of periop- erative routine blood tests in predicting 5-year survival of patients with stage I LC. Methods: This study included 536 consecutive patients with stage I LC who underwent preoperative chest computed tomography followed by surgical resection. The CAC score was measured by commercially available, fully automated artificial intelligence software. The primary outcome was the 5-year overall survival rate. Results: A total of 110 patients (20.5%) had a CAC score greater than or equal to 400, 149 (27.8%) between 100 and 399, and 277 (51.7%) had less than 100. Male smokers had the highest CAC values: 32% compared with only 17% of nonsmokers. Females had lower CAC values compared with males both in smokers and nonsmokers: CAC greater than or equal to 400 only for 10% of smoking females and 0% in nonsmoking females. The 5-year survival was 80.3% overall, 84.7% in CAC less than 100, 77.5% in CAC 100 to 399, and 73.5% in CAC greater than or equal to 400 (p 1/4 0.0047). Conclusions: We observed that the CAC score predicted the 5-year overall survival in patients with resected stage I LC, both alone and combined with the modified routine blood test score. These results open new prospects for the prevention of noncancer mortality in patients with early-stage LC. (c) 2025 The Authors. Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).both alone and combined with the modified routine blood test score. These results open new prospects for the prevention of noncancer mortality in patients with early-stage LC. (c) 2025 The Authors. Published by Elsevier Inc. on behalf of the International Association for the Study of Lung Cancer. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).