Coronary artery calcification is not associated with survival in advanced gastric and gastroesophageal junction cancer: a secondary analysis of the EXPAND trial
- 1Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, Leipzig, 04103 Germany
- 2Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
- 3Department of Medicine II, University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Cancer Center Central Germany (CCCG), Leipzig, 04103 Germany
Abstract
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.
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BibTeX
@article{meyer2026coronary,
title = {{Coronary artery calcification is not associated with survival in advanced gastric and gastroesophageal junction cancer: a secondary analysis of the EXPAND trial}},
author = {Hans-Jonas Meyer and Tihomir Dermendzhiev and Paul-Philipp Jacobs and Daniele Romeo and Gertraud Stocker and Timm Denecke and Florian Lordick and Ulrich T. Hacker},
journal = {Journal of Cancer Research and Clinical Oncology},
year = {2026},
month = nov,
doi = {10.1007/s00432-026-06654-y},
url = {https://doi.org/10.1007/s00432-026-06654-y},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Coronary artery calcification is not associated with survival in advanced gastric and gastroesophageal junction cancer: a secondary analysis of the EXPAND trial
AU - Hans-Jonas Meyer
AU - Tihomir Dermendzhiev
AU - Paul-Philipp Jacobs
AU - Daniele Romeo
AU - Gertraud Stocker
AU - Timm Denecke
AU - Florian Lordick
AU - Ulrich T. Hacker
PY - 2026
DA - 2026/11/03
JO - Journal of Cancer Research and Clinical Oncology
DO - 10.1007/s00432-026-06654-y
UR - https://doi.org/10.1007/s00432-026-06654-y
AB - 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.
SN - 0171-5216
SN - 1432-1335
ER -