Emphysema on Low-Dose CT Screening Predictive of Mortality Up to 25 Years
TUESDAY, Sept. 9, 2025 -- For adults with a history of smoking undergoing low-dose computed tomography (LDCT) for lung cancer screening, emphysema is predictive of mortality up to 25 years, according to a study published online Sept. 9 in Radiology.
Jessica González Gutiérrez, Ph.D., M.P.H., from the Arnau de Vilanova and Santa Maria University Hospital in Madrid, and colleagues conducted a prospective cohort study to examine whether a single visual emphysema score at LDCT is predictive of 25-year mortality from all causes, chronic obstructive pulmonary disease (COPD), and cardiovascular disease (CVD). Asymptomatic adults aged 40 to 85 years with a history of smoking underwent baseline LDCT screening for lung cancer and were followed for a median of 23.3 years.
The researchers found that 2,637 (29.1 percent) of the 9,047 participants had emphysema (mild, moderate, and severe in 21.1, 5.7, and 2.4 percent, respectively). Emphysema was independently predictive of all-cause mortality, COPD mortality, and CVD mortality (hazard ratios [95 percent confidence intervals], 1.29 [1.21 to 1.38; P < 0.001], 3.29 [2.59 to 4.18; P < 0.001], and 1.14 [1.01 to 1.29; P = 0.04], respectively). There was a dose-response relationship seen between emphysema severity and all-cause and COPD mortality, which was not observed for CVD mortality. Emphysema remained associated with COPD mortality (hazard ratio, 3.06; 95 percent confidence interval, 2.40 to 3.90; P < 0.001), but not with CVD mortality (hazard ratio, 1.04; 95 percent confidence interval, 0.91 to 1.18; P = 0.59), in the adjusted competing risk analysis.
"Clinically, these findings suggest emphysema is not merely an incidental CT finding, but a distinct disease entity associated with worst outcomes and increased mortality, not only from lung cancer but also from respiratory and cardiovascular diseases," Claudia I. Henschke, Ph.D., M.D., from the Icahn School of Medicine at Mount Sinai in New York City, said in a statement.
Several authors disclosed ties to the medical technology industry.
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