Cardiovascular

Coronary artery calcification is not associated with survival in advanced gastric and gastroesophageal junction cancer: a secondary analysis of the EXPAND trial.

Meyer H, Dermendzhiev T, et al. • Journal of cancer research and clinical oncology • 2026

PubMed 42975671 DOI 10.1007/s00432-026-06654-y

TL;DR

CT-defined CAC scoring has no relevant prognostic impact in advanced gastric and gastroesophageal junction cancer undergoing first-line chemotherapy, and the study cannot confirm the promising results for CAC scoring in lung cancer patients.

Key Findings

Results

Coronary artery calcification (CAC) was not associated with overall survival when analysed as a continuous variable in advanced gastric or gastroesophageal junction cancer.

Univariable Cox regression gave HR 0.99 (95% CI 0.96-1.02, p = 0.74).
CAC was measured semiquantitatively with the visual Weston method on baseline CT scans.
The cohort comprised 785 patients with unresectable locally advanced or metastatic disease from the phase III EXPAND trial.

Results

Dichotomized CAC (absent versus present) was not significantly associated with overall survival.

Univariable Cox regression gave HR 1.08 (95% CI 0.92-1.26, p = 0.34).
Similar null results were reported in further subgroup analyses.
Kaplan-Meier curves and multivariable Cox regression were used to test the effect of CAC on mortality.

Results

CAC burden was low in this population, and many patients had no visible calcification.

The median CAC score was 1 (IQR 0; 3).
337 patients (42.9%) had no visible CAC (CAC score 0).

Results

Male patients had significantly higher CAC scores than female patients.

Median CAC score was 1 in men versus 0 in women (p < 0.0001).
Group differences were tested with the Mann-Whitney-U test and ANOVA.

Conclusions

The authors concluded that CT-defined CAC scoring has no relevant prognostic value in this setting and does not replicate findings reported in lung cancer.

Patients were undergoing first-line chemotherapy with cisplatin/capecitabine ± cetuximab in the EXPAND trial.
The study was a secondary analysis of baseline CT images, with overall survival as the primary endpoint.

What This Means

This study asked whether calcium buildup in the heart's arteries, which can be seen on the CT scans already done to stage cancer, could help predict how long people with advanced stomach or gastroesophageal junction cancer will live. Earlier research in some other cancers, notably lung cancer, had suggested a link. The researchers looked at baseline CT scans from 785 patients in the EXPAND clinical trial, scoring calcification by eye using a visual scale. They found no link between coronary calcification and survival. This held whether calcification was treated as a score or simply as present versus absent, and it held in additional subgroup analyses. Calcification was generally mild: about 43% of patients had none visible. Men had higher scores than women. This research suggests that coronary calcium scoring on routine CT scans is not a useful way to predict survival in advanced stomach and gastroesophageal junction cancer treated with first-line chemotherapy. The results do not support extending the promising lung cancer findings to this cancer type. The study used a visual scoring method in a trial population, so it speaks only to this particular setting.

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Citation

Meyer H, Dermendzhiev T, Jacobs P, Romeo D, Stocker G, Denecke T, et al.. (2026). Coronary artery calcification is not associated with survival in advanced gastric and gastroesophageal junction cancer: a secondary analysis of the EXPAND trial.. Journal of cancer research and clinical oncology. https://doi.org/10.1007/s00432-026-06654-y

Key Findings

What This Means

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