Screening for Lung Cancer in the HIV Patient

描述（由申请人提供）：约翰霍普金斯大学hiv血清阳性患者的初步数据表明肺癌死亡率很高。我们获得了87例在该机构接受治疗的hiv血清阳性肺癌患者。几乎所有的患者都是年轻的（中位年龄46岁），来自巴尔的摩内城的非裔美国男性，有强烈的吸烟史。吸烟率为97%，其中89%为当前吸烟者。尽管对患者的艾滋病毒疾病进行了仔细的随访，但只有4.6%的艾滋病毒阳性肺癌患者最初出现了1期疾病，只有11名患者（13%）能够接受手术。近5年来，共发表了6项针对18387例肺癌高危患者的大规模CT肺癌筛查试验。在检测到的140例肺癌中，79%（110/140）为1期疾病。这与未进行CT筛查的1期肺癌患者的24%形成鲜明对比。这表明CT筛查在发现小的早期肺癌方面是敏感的。我们假设，CT筛查严重的hiv血清阳性吸烟者将发现比目前更高比例的1期肺癌。该项目是一项前瞻性队列研究，将招募200名目前或以前有至少20包年吸烟史的hiv血清阳性吸烟者。我们预计仅第一年就会有18例肺癌病例。具体目的1探讨在螺旋CT筛查的hiv阳性重度吸烟者和历史对照组之间，是否可以确定肺癌诊断时hiv阳性患者的分期分布差异。我们的第二个具体目标是建立一个血清、痰和组织样本库，这些样本来自筛选的hiv阳性吸烟者。我们的第三个具体目标是使用特异性目标2中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.