Longitudinal Mediastinal Lymph Node Dynamics Associate With Mortality and Fibrosis Progression in Fibrotic...

Area of Science:

• Pulmonary Medicine
• Radiology
• Oncology

Background:

• Mediastinal lymph node (MLN) enlargement is common in fibrotic interstitial lung disease (ILD).
• The dynamic behavior and prognostic significance of MLN enlargement in ILD are not well understood.
• Current risk stratification models for ILD do not incorporate MLN characteristics.

Purpose of the Study:

• To determine if MLN size, count, and progression on HRCT associate with disease progression and survival in fibrotic ILD.
• To assess if MLN metrics improve the predictive accuracy of existing clinical risk models.
• To validate findings in an independent patient cohort.

Main Methods:

• Prospective cohort study of 1,122 patients with fibrotic ILD, with independent replication in 181 patients.
• Standardized radiologic criteria for MLN scoring and deep texture analysis for fibrosis quantification.
• Cox and linear mixed-effects models used to evaluate associations with outcomes; model discrimination assessed using Harrell's C-index and decision curve analysis.

Main Results:

• Baseline MLN enlargement (≥10 mm) was found in 67% of patients and independently associated with worse transplant-free survival (TFS).
• MLN progression was linked to increased mortality and modified the association between fibrosis progression and survival.
• MLN metrics provided complementary prognostic information and modestly improved risk model discrimination when added to ILD-GAP or PPF status.

Conclusions:

• MLN burden and progression are quantifiable imaging biomarkers associated with adverse outcomes in fibrotic ILD.
• Incorporating MLN metrics into clinical models enhances risk stratification accuracy.
• MLN assessment holds potential for improved management and prognostication in fibrotic ILD.