Prospective CT screening for lung cancer in a high-risk population: HIV-positive smokers
| Autor: | Beatrice Mudge, Gregory Taylor, Gregory D. Kirk, Mario D. Terán, Maria Geronimo, Dan Li, Malcolm V. Brock, Celis Sam, Genevieve Pridham, Robert H. Brown, Alicia Hulbert, Marian Harline, Michelle Porter, Travis Brown, James G. Herman, Brad Drummond, Beverly Lee, Craig M. Hooker, Elizabeth Weihe, Christian A. Merlo, Kristen Rodgers, Richard D. Moore, Solange Cox, John Wrangle, Jeanne C. Keruly, Eliott Fishman, Karen M. Horton, Salina Tsai |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Multivariate analysis Lung Neoplasms medicine.medical_treatment Population Article Risk Factors Lung cancer screening Internal medicine Epidemiology HIV Seropositivity Computed tomography screening medicine Prevalence Humans Prospective Studies education Lung cancer Early Detection of Cancer education.field_of_study Lung business.industry Incidence Smoking Age Factors HIV Cancer respiratory system Middle Aged medicine.disease 3. Good health respiratory tract diseases CD4 Lymphocyte Count medicine.anatomical_structure Oncology Pulmonary Emphysema High-risk populations Smoking cessation Female Radiology business Tomography X-Ray Computed |
| Zdroj: | Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer. 9(6) |
| ISSN: | 1556-1380 |
| Popis: | Background: Epidemiological evidence suggests that HIV-infected individuals are at increased risk of lung cancer, but no data exist because large computed tomography (CT) screening trials routinely exclude HIV-infected participants. Methods: From 2006 to 2013, we conducted the world's first lung cancer screening trial of 224 HIV-infected current/former smokers to assess the CT detection rates of lung cancer. We also used 130 HIV-infected patients with known lung cancer to determine radiographic markers of lung cancer risk using multivariate analysis. Results: Median age was 48 years with 34 pack-years smoked. During 678 person-years, one lung cancer was found on incident screening. Besides this lung cancer case, 18 deaths (8%) occurred, but none were cancer related. There were no interim diagnoses of lung or extrapulmonary cancers. None of the pulmonary nodules detected in 48 participants at baseline were diagnosed as cancer by study end. The heterogeneity of emphysema across the entire lung as measured by CT densitometry was significantly higher in HIV-infected subjects with lung cancer compared with the heterogeneity of emphysema in those without HIV ( p ⩽ 0.01). On multivariate regression analysis, increased age, higher smoking pack-years, low CD4 nadir, and increased heterogeneity of emphysema on quantitative CT imaging were all significantly associated with lung cancer. Conclusions: Despite a high rate of active smoking among HIV-infected participants, only one lung cancer was detected in 678 patient-years. This was probably because of the young age of participants suggesting that CT screening of high-risk populations should strongly consider advanced age as a critical inclusion criterion. Future screening trials in urban American must also incorporate robust measures to ensure HIV patient compliance, adherence, and smoking cessation. |
| Databáze: | OpenAIRE |
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