Lung Cancer in Patients with Chronic Obstructive Pulmonary Disease. Development and Validation of the COPD Lung Cancer Screening Score

Abstract

Rationale: Patients with chronic obstructive pulmonary disease (COPD) are at high risk for lung cancer (LC) and represent a potential target to improve the diagnostic yield of screening programs.Objectives: To develop a predictive score for LC risk for patients with COPD.Methods: The Pamplona International Early Lung Cancer Detection Program (P-IELCAP) and the Pittsburgh Lung Screening Study (PLuSS) databases were analyzed. Only patients with COPD on spirometry were included. By logistic regression we determined which factors were independently associated with LC in PLuSS and developed a COPD LC screening score (COPD-LUCSS) to be validated in P-IELCAP.Measurements and Main Results: By regression analysis, age greater than 60, body mass index less than 25 kg/m 2 , pack-years history greater than 60, and emphysema presence were independently associated with LC diagnosis and integrated into the COPD-LUCSS, which ranges from 0 to 10 points. Two COPD-LUCSS risk categories were proposed: low risk (scores 0-6) and high risk (scores 7-10). In comparison with low-risk patients, in both cohorts LC risk increased 3.5-fold in the high-risk category.Conclusions: The COPD-LUCSS is a good predictor of LC risk in patients with COPD participating in LC screening programs. Validation in two different populations adds strength to the findings.

Airflow Limitation and Histology Shift in the National Lung Screening Trial. The NLST-ACRIN Cohort Substudy

“…In the study by Sanchez-Salcedo and colleagues, sensitivity of the eligibility criteria was substantially increased when the presence of airflow limitation or emphysema was added to the current NLST-based eligibility criteria (39). Collectively, these findings suggest that when risk stratifying current and former smokers for their lung cancer risk, variables related to susceptibility to COPD (age, smoking history, self-reported COPD, low body mass index, genetic factors, CT emphysema, or lung function) can be combined to derive a more precise overall lung cancer risk (23,25,38,(42)(43)(44)(45).…”

“…However, the NLST-ACRIN cohort appears to be representative of the wider NLST population as the demographic variables of this subgroup are comparable to those of the full study (Table 1). Consistent with other CT screening studies (11,14,17,18,39,45), only prebronchodilator airflow limitation was used in this study to define COPD status. Such an approach allows for greater comparability with these existing studies and better reflects the community-based (epidemiological) use of spirometry as a screening tool for airflow limitation.…”

Relationships between chronic obstructive pulmonary disease and lung cancer: biological insights

“…In this regard, low-dose computerized tomography (LDCT) has been proposed as a useful screening tool for LC (85). In keeping with, several authors (3,4,86,87) have demonstrated the benefits of LDCT in the early diagnosis of LC among smokers. Nonetheless, other authors have claimed that in LC screening programs, LDCT should not be still widely applied in the general population up until more convincing results are published (2).…”

The Impact of Emphysema on Chronic Obstructive Pulmonary Diseases

“…In an effort to help identify those COPD patients at higher risk for lung cancer development, our group developed and validated the COPD Lung Cancer Screening Score (COPD-LUCSS) 21 . The COPD-LUCSS includes age, pack-years history, BMI and presence of radiological emphysema.…”