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KEY WORDS: chronic obstructive pulmonary disease; DLCO; lung cancer; screening
ABBREVIATIONS: ATS = American Thoracic Society; AUC = area Pulmonary and Critical Care Department (Dr Cote), Bay Pines VA
under the curve; BODE = Body Mass Index, Airflow Obstruction, Medical Healthcare System, Bay Pines, FL; and Pulmonary Department
Dyspnea, Exercise Performance database; DLCO = diffusing capacity (Drs Pinto-Plata, Divo, and Celli), Brigham and Women’s Hospital,
for carbon monoxide; ERS = European Respiratory Society; Harvard Medical School Boston, MA.
GOLD = Global Initiative for COPD; HR = hazard ratio; LC = y
Deceased.
lung cancer; LDCT = low-dose CT; LUCSS = Lung Cancer FUNDING SUPPORT: This work was supported (in part) by a grant
Screening Score (RD12/0036/0062) from Red Temática de Investigación Cooperativa
AFFILIATIONS: From the Pulmonary Department (Drs de-Torres and en Cáncer, Instituto de Salud Carlos III, Spanish Ministry of Econ-
Zulueta), Clínica Universidad de Navarra, Pamplona, Spain; Pulmo- omy and Competitiveness & European Regional Development Fund
nary Department (Dr Marín), Hospital Universitario Miguel Servet, “Una manera de hacer Europa,” Spanish Ministry of Health FIS
Instituto Aragones Ciencias Salud and CIBER Enfermedades Respira- Projects: PI04/2404, PI07/0792, PI10/01652, PI11/01626 and PI15/
torias, Zaragoza, Spain; Pulmonary Department (Dr Casanova), Hos- 02157 from Spanish Ministry of Science and Innovation (project
pital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research ADE 10/00028).
Unit (Dr Casanova), Hospital Ntra Sra de Candelaria, Tenerife, Spain;
journal.publications.chestnet.org 937
Statistical Analysis predictors as continuous variables showed that the model has a
Quantitative data with a normal distribution were expressed using the similar statistical performance before and after categorization.
mean and the SD. Quantitative data with non-normal distribution were To build the COPD-LUCSS-DLCO, we determined the relative
described with the median and the interquartile range. Qualitative data
weight of each predictor in the score. We assigned each predictor
were described using relative frequencies. We first confirmed by Cox
a value based on the ratio between its log hazard ratios and the
regression analysis that three of the previously selected variables lowest one obtained in the Cox analysis. The final COPD-LUCSS-
included in the COPD-LUCSS (age > 60 years, pack-years > 60, DLCO is obtained by adding the value of each predictor. The
BMI < 25 kg/m2) were also independently associated with LC death
COPD-LUCSS-DLCO risk categories were selected after visual
in this cohort. inspection of the LC risk profile. Using the low-risk category as a
reference, Cox regression was used to explore the association
To determine the threshold of the categorical variables to be included between COPD-LUCSS-DLCO categories and the probability of LC
in the score, we first divided each continuous variable in quartiles or
diagnosis.
quintiles. We then visually compared their Kaplan-Meier curves and
selected the best cutoff values of each predictive variable (data not A receiver operating characteristic analysis determined the new
shown). We selected age > 60 years, pack-years > 60, and BMI COPD-LUCSS-DLCO discriminative capacity for LC death in each
< 25. To determine the best cutoff value for DLCO, we used similar spirometric GOLD stage. Significance for all tests was established at
methodology choosing the following thresholds: DLCO > 80%, a two-tailed P value # .05. Calculations were made with SPSS
79% to 60%, 59% to 40%, 39% to 20%, and < 20%. The use of the version, 20.0 Inc. (IBM).
journal.publications.chestnet.org 939
score, the relative weight of each variable in the score
0.3
has changed as follows: BMI < 25 from 1 to 1.5; pack-
Probability of lung cancer death
The present study has several limitations. Firstly, the In summary, the COPD-LUCSS-DLCO, now including
findings are restricted to the type of patients with COPD DLCO < 60% instead of the presence of CT-detected
here represented (ie, male patients with COPD in GOLD emphysema, allows the identification of patients with
grades 1-3 seen in pulmonary clinics at tertiary care COPD at high risk of death from LC. A prospective
hospitals). Whether COPD-LUCSS-DLCO also study in an LC screening population is now needed to
identifies higher risk patients in the primary care setting confirm these findings.
journal.publications.chestnet.org 941
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None declared (J. M. M., V. P.-P., M. D., Respir Crit Care Med. 2011;184(8):
for carbon monoxide (DLCO), and
C. Cote, and B. R. C.). 913-919.
quantitative computed tomography
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Additional information: The e-Figures can
quantitation of emphysema is correlated 21. Wilson DO, Weissfeld JL, Balkan A, et al.
be found in the Supplemental Materials with selected lung function values in stable Association of radiographic emphysema
section of the online article. COPD. Respiration. 2012;83(5):383. and airflow obstruction with lung cancer.
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