Kunihiro Yagihashi MD, Presenter: Nothing to Disclose

David Augustine Lynch MBBCh, Abstract Co-Author: Research support, Siemens AG Scientific Advisor, PAREXEL International Corporation Consultant, Boehringer Ingelheim GmbH Consultant, InterMune, Inc Consultant, Gilead Sciences, Inc Consultant, F. Hoffmann-La Roche Ltd Consultant, Veracyte, Inc Research support, Johnson & Johnson Research support, AstraZeneca PLC

Jason M. Huckleberry MD, Abstract Co-Author: Nothing to Disclose

Jordan Zach, Abstract Co-Author: Nothing to Disclose

Kevin Flaherty, Abstract Co-Author: Consultant, Boehringer Ingelheim GmbH Speakers Bureau, Boehringer Ingelheim GmbH Consultant, FibroGen, Inc Consultant, F. Hoffmann-La Roche Ltd Consultant, Gilead Sciences, Inc Data Safety Monitoring Board, Gilead Sciences, Inc Consultant, Ikaria, Inc Consultant, ImmuneWorks Consultant, AstraZeneca PLC Consultant, Novartis AG Consultant, Takeda Pharmaceutical Company Limited Consultant, Vertex Pharmaceuticals Incorporated Consultant, Veracyte, Inc Grant, Bristol-Myers Squibb Company Speakers Bureau, GlaxoSmithKline plc Speakers Bureau, Forest Laboratories, Inc Royalties, UpToDate, Inc

Eric Yow, Abstract Co-Author: Nothing to Disclose

Kevin J. Anstrom, Abstract Co-Author: Nothing to Disclose

Marvin Schwarz, Abstract Co-Author: Nothing to Disclose

Yasuo Nakajima MD, Abstract Co-Author: Nothing to Disclose

To identify the relationship between CT pattern and survival in a large population of subjects enrolled in multicenter studies of idiopathic pulmonary fibrosis.

We retrospectively reviewed the HRCT findings in 538 participants in three studies sponsored by the IPFNET study network. CT appearances were classified by two thoracic radiologists according to ATS criteria as UIP, possible UIP, and inconsistent with UIP. Univariate and multivariate analysis with Cox proportional hazards regression models were used for the correlation between CT and physiological features and survival.

Of the 538 cases, 304 (56.5%) had a UIP pattern on HRCT, 113 (21%) had possible UIP, and 121 (22.5%) had a pattern inconsistent with UIP. There were 38 deaths in the follow-up period. The UIP group was significantly older, more likely to be current or former smokers, had lower FVC% predicted, DLCO% predicted, and a shorter six-minute walk test compared to the other two groups. On univariate analysis, the survival for the groups with possible UIP pattern and CT inconsistent with UIP was similar, but subjects with UIP had shorter survival than the other groups (p = .032) (median survival in months – 49.9, 49.1, 44.3, respectively). The CT extent of reticular abnormality and honeycombing, and the presence of honeycombing were significant predictors of survival (hazard ratios: 1.57, 1.51, and 2.58, respectively) (p=0.015, 0.0005, and 0.0185, respectively). Younger age, lower Borg dyspnea index scores after a walk test, lower total score on St. George’s Respiratory Questionnaire, and greater six-minute walk test distance were also significant predictors of survival (hazard ratios: 1.06, 1.24, 1.05, and 0.99, respectively) (p=0.0044, 0.0083, <0.0001, and<0.0001, respectively). On multivariate Cox proportional hazards analysis, CT pattern, FVC % predicted, DLco % predicted, total score on St. George’s Respiratory Questionnaire and six-minute walk test distance were all significant predictors of survival (p=0.05, 0.04, <0.0001, 0.03, and 0.05, respectively).

In subjects enrolled in IPF clinical trials, survival of subjects with possible UIP pattern and findings inconsistent with UIP was similar, but subjects with UIP had shorter survival.

Categorization of UIP by CT may influence prognosis.

Yagihashi, K, Lynch, D, Huckleberry, J, Zach, J, Flaherty, K, Yow, E, Anstrom, K, Schwarz, M, Nakajima, Y, HRCT Classification and Survival in a Large Population of Subjects Enrolled in Multicenter Studies of Idiopathic Pulmonary Fibrosis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14002593.html