Screening for Lung Cancer in the HIV Patient

描述(由申请人提供)：约翰霍普金斯大学艾滋病毒血清阳性患者的初步数据表明，肺癌的死亡率很高。我们获得了87例HIV血清阳性的肺癌患者，他们曾在该机构接受治疗。几乎所有的患者都是年轻的(中位年龄46岁)，来自巴尔的摩市中心的非裔美国男性，有很强的吸烟史。吸烟率为97%，其中89%是现在吸烟者。尽管患者的HIV疾病得到了仔细的跟踪，但只有4.6%的HIV阳性肺癌患者最初出现了第一阶段的疾病，只有11名患者(13%)能够接受手术。在过去的5年里，已经发表了6项大规模计算机断层扫描(CT)肺癌筛查试验，涉及18,387名肺癌高危患者。在发现的140例肺癌中，79%(110/140)为一期肺癌。相比之下，没有CT筛查的1期肺癌患者中有24%的人患有肺癌。这表明CT筛查在发现早期小肺癌方面是敏感的。我们假设，对重度HIV血清阳性吸烟者进行CT筛查，将发现比目前检测到的更高比例的1期肺癌。该项目是一项前瞻性队列研究，将招募200名现在或以前有至少20年吸烟史的艾滋病毒血清阳性吸烟者。我们预计仅在第一年就会有18例肺癌。具体目标1解决是否可以确定通过螺旋CT筛查的艾滋病毒阳性重度吸烟者和历史对照之间在肺癌诊断时艾滋病毒阳性患者的阶段分布是否存在差异。我们的第二个具体目标是建立一个来自这些HIV阳性吸烟者的血清、痰和组织的样本库。我们的第三个具体目标是使用特殊目标2收集的血清和痰的表观遗传学分析作为低剂量螺旋CT的补充方法，以便区分放射学上不确定的结节是分子阳性还是阴性。

DESCRIPTION (provided by applicant): Preliminary data from HIV-seropositive patients at Johns Hopkins demonstrate a high rate of death from lung cancer. We derived 87 cases of HIV-seropositive patients with lung cancer who had been treated at the institution. Almost all patients were young (median age 46 years), African-American males from inner city Baltimore with a strong history of cigarette smoking. The prevalence of smoking was 97%, with 89% being current smokers. Despite patients being carefully followed for their HIV disease, only 4.6% of the HIV-positive lung cancer patients initially presented with stage 1 disease, and only 11 patients (13%) were able to undergo surgery. Over the past 5 years, six large-scale computed tomography (CT) lung cancer screening trials of 18,387 patients at high risk for lung cancer have been published. Of 140 lung cancers detected, 79% (110/140) had stage 1 disease. This contrasts with 24% of patients presenting with stage 1 lung cancer patients without CT screening. This suggests that CT screening is sensitive in detecting small, early stage lung cancer. We hypothesize that CT screening of heavy HIV-seropositive smokers will detect a higher proportion of stage 1 lung cancers than are currently being detected. This project is a prospective cohort study that will enroll 200 HIV-seropositive smokers who have current or previous smoking history of at least 20 pack years. We anticipate 18 lung cancers in the first year alone. Specific aim 1 addresses if differences in stage distribution of HIV-positive patients at lung cancer diagnosis can be determined between those HIV-positive heavy smokers who are screened by spiral CT and historical controls. Our second specific aim focuses on the establishment of a specimen bank of serum, sputum, and tissue from these screened HIV-positive smokers. Our third specific aim is to use epigenetic analysis of sera and sputa collected in Specific Aim 2 as a complementary approach to low dose helical CT in order to discriminate radiologically indeterminate nodules as either molecularly positive or negative.