title: Identification of COPD Patients at High Risk for Lung Cancer Mortality Using the COPD-LUCSS-DLCO.
abstract: BACKGROUND
  The COPD-Lung Cancer Screening Score (COPD-LUCSS) is a tool designed to help identify patients with COPD with the highest risk of developing lung cancer (LC). The COPD-LUCSS includes the determination of radiological emphysema, a potential limitation for its implementation in clinical practice. The diffusing capacity for carbon monoxide (DLCO) is a surrogate marker of emphysema and correlates well with CT-determined emphysema.
  
  
  OBJECTIVE
  To explore the use of the COPD-LUCSS using the DLCO instead of radiological emphysema, as a tool to identify patients with COPD at higher risk of LC death.
  
  
  METHODS
  The Body Mass Index, Airflow Obstruction, Dyspnea, Exercise Performance international cohort database was analyzed. By logistic regression analysis, we confirmed that the other parameters included in the COPD-LUCSS (age > 60, pack-years > 60, BMI < 25) were independently associated with LC death. We selected the best cutoff value for DLCO that independently predicted LC death. We then integrated the new COPD-LUCSS-DLCO assigning points to each parameter according to its hazard ratio value in the Cox regression model. The score ranges from 0 to 8 points.
  
  
  RESULTS
  By regression analysis, age > 60, BMI <25 kg/m(2), pack-year history > 60, and DLCO < 60% were independently associated with LC diagnosis. Two COPD-LUCSS-DLCO risk categories were identified: low risk (scores 0-3) and high risk (scores 3.5-8). In comparison to patients at low risk, risk of death from LC increased 2.4-fold (95% CI, 2.0-2.7) in the high-risk category.
  
  
  CONCLUSIONS
  The COPD-LUCSS using DLCO instead of CT-determined emphysema is a useful tool to identify patients with COPD at risk of LC death and may help in its implementation in clinical practice.
authors.affiliation: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain. Electronic address: jupa65@hotmail.com.
authors.forename: Juan P
authors.initials: JP
authors.lastname: de-Torres
authors.affiliation: Pulmonary Department, Hospital Universitario Miguel Servet, Instituto Aragones Ciencias Salud and CIBER Enfermedades Respiratorias, Zaragoza, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Marín
authors.affiliation: Pulmonary Department, Hospital Ntra Sra de Candelaria, Tenerife, Spain; Respiratory Research Unit, Hospital Ntra Sra de Candelaria, Tenerife, Spain.
authors.forename: Ciro
authors.initials: C
authors.lastname: Casanova
authors.affiliation: Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School Boston, MA.
authors.forename: Victor
authors.initials: V
authors.lastname: Pinto-Plata
authors.affiliation: Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School Boston, MA.
authors.forename: Miguel
authors.initials: M
authors.lastname: Divo
authors.affiliation: Pulmonary and Critical Care Department, Bay Pines VA Medical Healthcare System, Bay Pines, FL.
authors.forename: Claudia
authors.initials: C
authors.lastname: Cote
authors.affiliation: Pulmonary Department, Brigham and Women's Hospital, Harvard Medical School Boston, MA.
authors.forename: Bartolome R
authors.initials: BR
authors.lastname: Celli
authors.affiliation: Pulmonary Department, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Javier J
authors.initials: JJ
authors.lastname: Zulueta
mesh_terms: D000367:Age Factors; D000368:Aged; D015992:Body Mass Index; D002248:Carbon Monoxide; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D055088:Early Detection of Cancer; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008175:Lung Neoplasms / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D011656:Pulmonary Emphysema / Q000000981:diagnostic imaging*; D012372:ROC Curve; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology*; D014057:Tomography, X-Ray Computed; D014797:Vital Capacity
chemical_list: D002248:Carbon Monoxide
keywords: DLCO; chronic obstructive pulmonary disease; lung cancer; screening