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@ARTICLE{Kaaks:182140,
      author       = {R. Kaaks$^*$ and E. Christodoulou$^*$ and E. Motsch$^*$ and
                      V. Katzke$^*$ and M. O. Wielpütz and H.-U. Kauczor and C.
                      P. Heussel and M. Eichinger and S. Delorme$^*$},
      title        = {{L}ung function impairment in the {G}erman {L}ung {C}ancer
                      {S}creening {I}ntervention {S}tudy ({LUSI}): prevalence,
                      symptoms, and associations with lung cancer risk, tumor
                      histology and all-cause mortality.},
      journal      = {Translational Lung Cancer Research},
      volume       = {11},
      number       = {9},
      issn         = {2218-6751},
      address      = {[S.l.]},
      reportid     = {DKFZ-2022-02457},
      pages        = {1896 - 1911},
      year         = {2022},
      note         = {#EA:C020#LA:E010#},
      abstract     = {Lung cancer screening may provide a favorable opportunity
                      for a spirometry examination, to diagnose participants with
                      undiagnosed lung function impairments, or to improve
                      targeting of computed tomography (CT) screening intensity in
                      view of expected net benefit.Spirometry was performed in the
                      CT screening arm (n=2,029) of the German Lung Cancer
                      Screening Intervention Study (LUSI)-a trial examining the
                      effects of annual CT screening on lung cancer mortality, in
                      50-69-year-old long-term smokers. Participants were
                      classified as having chronic obstructive pulmonary disease
                      (COPD) [forced expiration in one second (FEV1)/forced vital
                      lung capacity (FVC) <0.7], preserved ratio impaired
                      spirometry (PRISm; FEV1/FVC ≥0.7 and $FEV1\%$ predicted
                      $<80\%),$ or normal spirometry. Descriptive statistics were
                      used to examine associations of COPD or PRISm with
                      respiratory symptoms, and self-reported medical diagnoses of
                      respiratory and other morbidities. Logistic regression and
                      proportional hazards regression were used to examine
                      associations of COPD and PRISm, as well as their
                      self-reported medical diagnoses, with risks of lung cancer
                      and all-cause mortality.A total of 1,987 screening arm
                      participants $(98\%)$ provided interpretable spirometry
                      measurements; of these, $34.3\%$ had spirometric patterns
                      consistent with either COPD $(18.6\%)$ or PRISm $(15.7\%).$
                      Two thirds of participants with COPD or PRISm were
                      asymptomatic, and only $23\%$ reported a previous medical
                      diagnosis concordant with COPD. Participants reporting a
                      diagnosis tended to be more often current and heavier
                      smokers, and more often had respiratory symptoms,
                      cardiovascular comorbidities, or more severe lung function
                      impairments. Independently of smoking history,
                      moderate-to-severe (GOLD 2-4) COPD (OR =2.14; $95\%$ CI:
                      1.54-2.98), and PRISm (OR =2.68; $95\%$ CI: 1.61-4.40), were
                      associated with increased lung cancer risk. Lung cancer
                      patients with PRISm less frequently had adenocarcinomas, and
                      more often squamous cell or small cell tumors, compared to
                      those with normal spirometry (n=45), and both PRISm and COPD
                      were associated with more advanced lung cancer tumor stage
                      for screen-detected cancers. PRISm and COPD, depending on
                      GOLD stage, were also associated with about 2- to 4-fold
                      increases in risk of overall mortality, which to 87 percent
                      had causes other than lung cancer.About one third of smokers
                      eligible for lung cancer screening in Germany have COPD or
                      PRISm. As these conditions were associated with detection of
                      lung cancer, spirometry may help identify populations at
                      high risk for death of lung cancer or other causes, and who
                      might particularly benefit from CT screening.},
      keywords     = {Spirometry (Other) / chronic obstructive pulmonary disease
                      (COPD) (Other) / lung cancer screening (Other) / mortality
                      (Other) / preserved ratio impaired spirometry (PRISm)
                      (Other)},
      cin          = {C020 / E010},
      ddc          = {610},
      cid          = {I:(DE-He78)C020-20160331 / I:(DE-He78)E010-20160331},
      pnm          = {315 - Bildgebung und Radioonkologie (POF4-315)},
      pid          = {G:(DE-HGF)POF4-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:36248328},
      pmc          = {pmc:PMC9554689},
      doi          = {10.21037/tlcr-22-63},
      url          = {https://inrepo02.dkfz.de/record/182140},
}