Lung Cancer in Patients with Human Immunodeficiency Virus Infection Compared with Historic Control Subjects
1992; Elsevier BV; Volume: 102; Issue: 6 Linguagem: Inglês
10.1378/chest.102.6.1704
ISSN1931-3543
AutoresKasi S. Sridhar, Maria Regina C. Flores, William A. Raub, Mario J. Saldana,
Tópico(s)Hepatitis C virus research
ResumoLung cancer infrequently may be associated with human immunodeficiency virus (HIV) infection. This retrospective case-control study was undertaken to determine if there were differences in age, sex, and stage distribution and in survival between HIV-positive and HIV-indeterminate lung cancer patients. We compared 19 patients with both pathologically verified lung cancer and HIV infection proved by serologic study with lung cancer patients with an indeterminate HIV status. Ail 19 HIV-positive lung cancer patients were men. This was significantly (p=0.004) different from the 69 percent male preponderance in 1,335 HIV-indeterminate lung cancer patients. Median ages of HIV-positive and HIV-indeterminate patients were 48 and 61 years, respectively. HIV-positive patients were significantly (p=0.0139) younger. Stage distribution was similar in both groups. Histologic features and smoking were not significantly different between the two groups. Survival data that were available in 16 HIV-positive patients were compared with 32 HIV-indeterminate control subjects matched for stage, age, sex, and race. The median survival was three months in the HIV-positive group and ten months in the HIV-indeterminate cohort. The survival was significantly different (p=0.002). There were no one-year survivors in HIV-positive lung cancer patients. Lung cancer infrequently may be associated with human immunodeficiency virus (HIV) infection. This retrospective case-control study was undertaken to determine if there were differences in age, sex, and stage distribution and in survival between HIV-positive and HIV-indeterminate lung cancer patients. We compared 19 patients with both pathologically verified lung cancer and HIV infection proved by serologic study with lung cancer patients with an indeterminate HIV status. Ail 19 HIV-positive lung cancer patients were men. This was significantly (p=0.004) different from the 69 percent male preponderance in 1,335 HIV-indeterminate lung cancer patients. Median ages of HIV-positive and HIV-indeterminate patients were 48 and 61 years, respectively. HIV-positive patients were significantly (p=0.0139) younger. Stage distribution was similar in both groups. Histologic features and smoking were not significantly different between the two groups. Survival data that were available in 16 HIV-positive patients were compared with 32 HIV-indeterminate control subjects matched for stage, age, sex, and race. The median survival was three months in the HIV-positive group and ten months in the HIV-indeterminate cohort. The survival was significantly different (p=0.002). There were no one-year survivors in HIV-positive lung cancer patients. Centers for Disease Control enzyme-linked immunosorbent assay Jackson Memorial Hospital Surveillance Epidemiology and End Result University of Miami Hospital and Clinics We reported data on 1,336 analytic lung cancer patients entered in the tumor registry of Jackson Memorial Hospital (JMH) and University of Miami Hospital and Clinics (UMHC) between 1977 and 1986.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar Neither Surveillance Epidemiology and End Result (SEER) nor our tumor registry recorded data on human immunodeficiency virus (HIV) infection.2Boring CC Squires TS Tong T Cancer statistics.CA. 1991; 42: 19-36Google Scholar Of the 1,336 patients with lung cancer previously presented,1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar one patient was known to be HIV positive. Data on HIV infection were unavailable in the other 1,335 patients. We identified 19 patients with both lung cancer and HIV infection, including one of the 1,336 patients mentioned earlier. Their conditions were diagnosed between 1986 and 1991 at our Medical Center Complex. Four patients were identified using the special immunology registry of HIV-positive patients at the Veterans Administration Medical Center (VAMC), Miami. The medical records discharge diagnostic codes and tumor registry data were used to identify 15 patients at JMH. The current analysis was undertaken to see if age, sex, and stage distribution and survival were different in HIV-positive lung cancer patients compared with HIV-indeterminate lung cancer patients. Nineteen men with both HIV infection and lung cancer formed the HIV-positive lung cancer group (Table 1, Table 2). HIV infection was confirmed by serologic study using enzyme-linked immunosorbent assay (ELISA)3Ward JW Grindon AJ Feorino PM Schable C Parvin M Allen JR Laboratory and epidemiologic evaluation of an enzyme immunoassay for antibodies to HTLV-III.JAMA. 1986; 256: 357-361Crossref PubMed Scopus (77) Google Scholar in all patients and by Western Blot method in most patients.4The Consortium for Retrovirus Serology StandardizationSerological diagnosis of human immunodeficiency virus by Western blot testing.JAMA. 1988; 260: 674-679Crossref PubMed Scopus (71) Google Scholar The histopathology and cytology slides were reviewed by light microscopy by at least two of the authors (including M. S.5Saldana MJ Diseases of the bronchi and lungs.in: Silverberg SG Principles and practice of surgical pathology. 2nd ed. Churchill Livingstone Ine, New York1990: 713-775Google Scholar) to reconfirm the diagnosis of lung cancer. The Centers for Disease Control (CDC) classification was used in the HIV group.6Centers for Disease ControlClassification system for human T-lymphotropic virus type III/lymphadenopathy associated virus infections.MMWR. 1986; 35: 334-339PubMed Google Scholar The comparison group of HIV-indeterminate (presumably negative) lung cancer group was extracted from the prior data set by deleting data on the patient known to have HIV infection.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar A comparison of gender distribution was done using 1,335 patients. Since all HIV-positive patients were men, comparison of stage was done using only men from a total of 1,335 patients (Table 3, Table 4). Staging was available in the comparison group in only 827 (90 percent) of the 919 men.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar Staging in the HIV-indeterminate group of patients was available only by the older Florida Cancer Data Staging System, an adaptation of the Summary Staging Guide of the Seer as previously described.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar, 7Sridhar KS Bounassi MJ Raub W Richman SP Clinical features of adenosquamous lung cancer in 127 patients.Am Rev Respir Dis. 1990; 142: 19-23Crossref PubMed Scopus (36) Google Scholar Although staging by the current International Staging System8Beahrs OH Henson DE Hutter RVP Myers MH Manual for staging of cancer. 3rd ed. JB Lippincott Co, Philadelphia1988: 115-121Google Scholar was available in the HIV-positive patients, the older staging system was used for comparison (Table 4).Table 1Patient Characteristics and the Status of HIV Infection*CDC Classification, W=white; B=black; H=Hispanic; PCP=Pneumocystis carinii pneumonia; PTB=pulmonary tuberculosis; KS=Kaposi's sarcoma; MAI=Mycobacterium avium intracellulare; SIADH=syndrome of inappropriate antidiuretic hormone; COPD=chronic obstructive pulmonary disease; DM=diabetes mellitus; IVDA=intravenous drug abuse.Patient No./Age, yr/RaceRisk Factor(s)Group*CDC Classification, W=white; B=black; H=Hispanic; PCP=Pneumocystis carinii pneumonia; PTB=pulmonary tuberculosis; KS=Kaposi's sarcoma; MAI=Mycobacterium avium intracellulare; SIADH=syndrome of inappropriate antidiuretic hormone; COPD=chronic obstructive pulmonary disease; DM=diabetes mellitus; IVDA=intravenous drug abuse.at DiagnosisCD4 Count/mm3T4:T8 RatioOpportunistic InfectionsOther Medical Problem(s) 1/45/WBlood transfusion in 19814130.03PCP, MAIMolluscum contagiosum DM, pancreatitis, COPD 2/42/BIVDA4190.10PCP, esophageal candidiasisPTB, intestinal obstruction 3/42/HHomosexual, IVDA42760.20NonePeptic ulcer, KS 4/53/BHomosexual, promiscuity26280.60NoneVocal cord polyp 5/52/WHomosexual4750.10PCP, oral candidiasisReiter's syndrome, KS 6/45/HHomosexual3NANANoneHypercalcemia, inguinal hernia, nephrolithiasis 7/57/WHomosexual43800.05PCP, oral candidiasisAIDS myopathy, aortic stenosis, COPD 8/63/BBlood transfusion in 1984, 198922330.61NonePTB 9/47/BPromiscuity25240.60NoneStroke, syphilis10/66/BNA31210.56Herpes labialisPTB, syphilis11/49/WHomosexual4630.10Anal candidiasisSyphilis, viral hepatitis12/52/BPromiscuity3840.30NoneViral hepatitis, myocardial infarction13/36/BIVDA4190.0Oral candidiasis, PCPPTB, fistula-in-ano14/36/BNone43300.30Oral candidiasisLung abscess, SIADH, PTB, COPD, syphilis15/62/BNone4600.10Oral candidiasisPTB16/47/BNone4NANAOral candidiasisPeptic ulcer, syphilis17/42/BPromiscuity23260.50NoneSyphilis18/46/HBlood transfusion in 1970, Promiscuity3990.10NonePeptic ulcer, pancreatitis intestinal obstruction19/48/BIVDA24330.50NoneHypertension, chest traumaTotal 19Homosexual 6,Group 1-0Mean 217Mean 0.28Candidiasis 8PTB 6, syphilis 6, COPD 3,Age: Mean 49Promiscuity 5, IVDA 4,Group 2-5Median 121Median 0.20PCP 5, MAI 1,viral hepatitis 2, KS 2,Median 47 yearsBlood transfusion 3,Group 3-4Herpes 1,pancreatitis 2, Reiter'sRace: B 12, W 4, H 3None 3, NA 1Group 4-10None 9syndrome 1* CDC Classification, W=white; B=black; H=Hispanic; PCP=Pneumocystis carinii pneumonia; PTB=pulmonary tuberculosis; KS=Kaposi's sarcoma; MAI=Mycobacterium avium intracellulare; SIADH=syndrome of inappropriate antidiuretic hormone; COPD=chronic obstructive pulmonary disease; DM=diabetes mellitus; IVDA=intravenous drug abuse. Open table in a new tab Table 2Lung Cancer in 19 HIV-Positive Patients*PS=Zubrod performance status; SVC=superior vena cava syndrome; RT=radiation therapy; CT=chemotherapy; NA=not available; ADENO=adenocarcinoma.Patient No./Age, yrHistologyStagePSClinical PresentationTherapySurvivait mo†Survival from diagnosis of lung cancer. 1/45AdenoIII T4N3MX2Dyspnea, pleural effusionRT2 2/42AdenoI T1NOMO1Fever, weight lossSurgery5 3/42Large cellIII T4NXMX2Chest painRefused1 4/53AdenosquamousIII T3N1M01Dyspnea, chest painRT10 5/52AdenoIV T2N3M12Fatigue, weight lossRTNA 6/45AdenoIV T2N2M12Chest painRefusedNA 7/57SquamousIV T4N3M12SVCRT2 8/63SquamousIV T4N3M12Dyspnea, cough, pleural effusionRefused1 9/47Large cell1T1N0M01Incidental finding on chest roentgenogramSurgery310/66SquamousII T2NXMO2Obstructive pneumoniaRefused411/49AdenoIV T4N3M11Cough, fatigue, arm tinglingCT212/52AdenoIV TXNXM12Obstructive pneumoniaRTNA13/36SquamousIV TXNXM12Cough, dyspneaRefused114/36Mixed small cell and large cellIV TXN2M11Fever, hemoptysisCT and RT815/62SquamousIII T3N1MX3Obstructive pneumoniaRT216/47SquamousIII T3NXMO1Fever, cough, weight lossRefused717/42Small cellIV T4N2M12Hip painRefused718/46AdenoI TIN0M01Fever, coughSurgery1 +19/48AdenoIV T4N2M12Fever, cough, hemoptysisRT1 +Total 19Adeno 8, squamous 6, largeStage 1-3PS1-7Cough 6, fever 5, dyspnea 4,RT 8, CT 2,Mean 4Mean 49, andcell 2, small cell 1, mixedStage II-lPS2-11obstructive pneumonia 3,surgery 3, none 7Median 3Median 47 yrsmall and large cell 1,Stage III-5PS3-1chest pain 3, hemoptysis 2adenosquamous 1Stage IV-10* PS=Zubrod performance status; SVC=superior vena cava syndrome; RT=radiation therapy; CT=chemotherapy; NA=not available; ADENO=adenocarcinoma.† Survival from diagnosis of lung cancer. Open table in a new tab Table 3Distribution in Men with Lung Carcinoma*p=0.0139 by χ2 test.Age, yrHIV Positive, No. (%)HIV Indeterminate Historic Controls, No.(%) 740101 (11)Total19 (100)918 (100)* p=0.0139 by χ2 test. Open table in a new tab Table 4Stage Distribution in Men with Lung Carcinoma*No significant differences by χ2 test.SEER StageHIV Positive, No. (%)HIV Indeterminate Historic Controls, No. (%)Local 4 (21)112 (13)Regional 4 (21)212 (26)Distant 11 (58)503 (61)Total19 (100)827 (100)* No significant differences by χ2 test. Open table in a new tab Survival data were not available in three HIV-positive patients. Survival comparisons were done using 16 HIV-positive patients and a matched historic group of lung cancer patients who were HIV indeterminate from the tumor registry.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar We chose two control subjects for each HIV-positive case (Table 5). Each HIV-positive patient was matched with a man of the same race and stage and±5 years in age. Control cases were extracted from the year 1986 back to 1977 until a matched control subject was identified. An attempt to match histologic features was not successful because of lack of a match. However, differences in histologic features were not significant (Table 5). Descriptive statistics included analysis of various patient characteristics and appropriate categoric analysis (χ2) for any association between variables. Survival analysis was done using the product limit method of Kaplan and Meier9Kaplan EL Meier P Nonparametric estimation from incomplete observations.J Am Stat Assoc. 1958; 53: 457-481Crossref Scopus (48514) Google Scholar using a statistical software program (BMDP, Solo 2.0, Los Angeles).10Hintz JL Solo statistical system version 3.0—survival analysis. BMDP Statistical Software, Ine, Los Angeles1989: 1-62Google ScholarTable 5HIV-Positive Lung Cancer Patients with Matched ControlsHIV PositiveHIV Indeterminate Historic Controls*No significant differences by χ2 test.Total1632Median age, yr4746Range, yr36-6636-69Local stage†SEER staging system (see text).48Regional stage48Distant stage816White510Black1122Male1632Female00Tobacco smoker1331Tobacco nonsmoker11Tobacco status unknown20Squamous610Adenocarcinoma517Large22Adenosquamous12Small cell11Mixed small and large cell10* No significant differences by χ2 test.† SEER staging system (see text). Open table in a new tab All 19 HIV-positive lung cancer patients were men. In the control group, 918 were men and 417 (31 percent) were women. The difference in gender distribution between these two groups was significant (p=0.004 by χ2 test). The male preponderance in HIV-positive lung cancer group was still significant (p=0.009) when analyzed using only the 15 JMH HIV-positive lung cancer patients by elimination of four VAMC patients (to eliminate the selection bias against women). Sixteen HIV-positive patients were smokers, one was a nonsmoker, and in two others the smoking history was not available. The range of cigarette smoking was 0 to 100 pack-years with a median of 60 pack-years. The median age for HIV-positive lung cancer patients was 47 years for all the 19 HIV-positive patients and 47 for the 16 HIV-positive patients, whose survival was analyzed (Table 5). The age distribution showed significantly younger patients (Table 3). Stage distribution showed no difference from HIV-indeterminate group (Table 4). Histologic subtypes in the 19 HIV-positive and the 1,335 HIV-indeterminate patients are shown in Table 6. The 95 percent confidence limits are large in the HIV-positive group due to the small number of patients. Although adenocarcinoma appeared more common and small cell carcinoma appeared less common in the HIV-positive group than the control group, these differences were not statistically significant. Survival of the 16 HIV-positive patients was different from the matched control subjects (Fig 1). Eight control patients were alive at the time of last follow-up after 5, 8, 11, 12, 38, 39, 50, and 68 months. The median survival of HIV-positive patients was three months and that of the control group was ten months. All HIV-positive patients were dead by ten months.Table 6Histologic Distribution in Patients with Lung Cancer by HIV StatusHistologic SubtypeHIV Positive, No.(%)HIV Indeterminate, No.(%)Squamous carcinoma6(33)433(32)Adenocarcinoma8(44)347(26)Small cell carcinoma1(6)249(19)Large cell carcinoma2(10)158(12)Adenosquamous carcinoma1(6)103(8)Broncholoalveolar carcinoma0(0)45(3)Mixed small and large1(6)0…*Mixed histologies were coded by dominant morphology. No significant differences between the two groups by χ2 test (5 df=4.680, p=0.4562).Total19(100)1335(100)* Mixed histologies were coded by dominant morphology. No significant differences between the two groups by χ2 test (5 df=4.680, p=0.4562). Open table in a new tab Patients with HIV infection have a plethora of thoracic diseases. Pneumocystis carinii, mycobacteria, and other opportunistic infections and malignant neoplasms such as Kaposi sarcoma and lymphoma are common.11Miller-Catchpole R Variakojis D Anastasi J Abrahams C Chicago Associated PathologistsThe Chicago AIDS autopsy study: opportunistic infections, neoplasms and findings from selected organ systems with a comparison to national data.Mod Pathol. 1989; 9: 277-293Google Scholar The signs and symptoms of these conditions may be similar to the common manifestations of lung cancer.7Sridhar KS Bounassi MJ Raub W Richman SP Clinical features of adenosquamous lung cancer in 127 patients.Am Rev Respir Dis. 1990; 142: 19-23Crossref PubMed Scopus (36) Google Scholar, 12Antunez de Mayolo J Sridhar KS Kundhardt B Rao RK Superior vena cava obstruction in a patient with chronic lymphocytic leukemia and lung cancer.Am J Clin Oncol. 1992; (in press): 15Google Scholar, 13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar Gallium scan is nonspecific because uptake may be seen in P carinii pneumonia, lymphoma, and lung cancer. Hence, lung cancer may be missed in some patients with HIV infection. Underdiagnosis may occur due to the difficulty in performing invasive diagnostic procedures due to the poor general and respiratory status and patient noncompliance. Bilateral hilar and/or mediastinal lymphadenopathy and superior vena cava syndrome may occur both in lung cancer and lymphoma.12Antunez de Mayolo J Sridhar KS Kundhardt B Rao RK Superior vena cava obstruction in a patient with chronic lymphocytic leukemia and lung cancer.Am J Clin Oncol. 1992; (in press): 15Google Scholar Brain lesions in patients with AIDS may be due to opportunistic infections, lymphoma, or metastases. Although lesions due to toxoplasmosis tend to occur in the basal ganglia and brain metastases in the junction of gray and white matter, radiologic appearance of brain metastases and cerebral toxoplasmosis may be similar, compounding the difficulty in diagnosis and treatment of a patient with AIDS and lung cancer. Lung cancer as a differential diagnosis must be entertained when one or more of the following features are present: presence of a mass lesion in the lung, unilateral hilar adenopathy, rib destruction, Pancoast's syndrome, hard and/or fixed scalene lymphadenopathy, phrenic and/or left recurrent nerve paralysis, and paraneoplastic syndromes commonly associated with lung cancer. However, the syndrome of inappropriate secretion of antidiuretic hormone may occur in patients with infections and/or cancer of the lung. Lung cancer may also be found unexpectedly during bronchoscopy and bronchoalveolar lavage in the workup of opportunistic infections in a patient with HIV infection. The drawbacks of this study are those inherent in a retrospective case-control study. The control group did not undergo serologic testing for HIV infection and may have included a small number of clinically unsuspected HIV-positive patients. The control group was historic and consisted of those with conditions diagnosed between 1977 and 1986 and the HIV-positive group had conditions diagnosed between 1986 and 1991. However, survival in lung cancer has remained unchanged over the years.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar, 2Boring CC Squires TS Tong T Cancer statistics.CA. 1991; 42: 19-36Google Scholar, 13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar The control subjects included no patients from the VAMC. Date of death was unavailable in three of the HIV-positive patients who were terminally ill at the time of last contact. Hence, it is unlikely that a more recent control group, a control group that included VAMC patients, or inclusion of survival data on all 19 HIV patients would have altered the conclusions reached. The data presented showed that HIV-positive lung cancer patients were significantly younger than other patients with lung cancer. In contrast, the median age of lung cancer patients at our center was 61 years.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar Median age of HIV-positive lung cancer patients was 48 years. The reason for the occurrence of lung cancer in HIV-positive patients at a younger age group is unknown. A potential explanation for this phenomenon may be the younger age of HIV-positive patients in general. Both HIV-positive and control lung cancer patients had more advanced stages1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar than reported by others.2Boring CC Squires TS Tong T Cancer statistics.CA. 1991; 42: 19-36Google Scholar, 13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar There was no correlation between the stage of lung cancer and CD4 counts. All HIV-positive lung cancer patients had low CD4 counts except one. All HIV-positive lung cancer patients described so far,14Irwin LE Begandy MK Moore TM Adenosquamous carcinoma of the lung and the acquired immunodeficiency syndrome.Ann Intern Med. 1984; 100: 158Crossref PubMed Scopus (52) Google Scholar, 15Moser III, RJ Tenholder MF Ridenour R Oat-cell carcinoma in transfusion-associated acquired immunodeficiency syndrome.Ann Intern Med. 1985; 103: 478Crossref PubMed Google Scholar, 16Nusbaum NJ Metastatic small cell carcinoma of the lung in a patient with AIDS.N Engl J Med. 1985; 312: 1706Crossref PubMed Scopus (14) Google Scholar, 17Braun MA Killam DA Remick SC Ruckdeschel JC Lung cancer in patients seropositive for human immunodeficiency virus.Radiology. 1990; 175: 341-343Crossref PubMed Scopus (62) Google Scholar, 18Karp J Marantz P Karpel JP Lung cancer in patients with acquired immune deficiency syndrome.Chest. 1991; 99: 88SGoogle Scholar, 19Monfardini S Vaccher E Pizzocaro G Stellini R Sinicco A Sabbatini S et al.Unusual malignant tumors in 49 patients with HIV infection.AIDS. 1989; 3: 449-452Crossref PubMed Google Scholar including the 19 cited in this report, were men. This may be due to male preponderance in both lung cancer and HIV infection. However, there is an increase of lung cancer in women.2Boring CC Squires TS Tong T Cancer statistics.CA. 1991; 42: 19-36Google Scholar, 13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar There is also increase of HIV infection in women.20Centers for Disease ControlMortality attributable to HIV infection/AIDS-United States 1981-1990.MMWR. 1991; 40: 41-44PubMed Google Scholar Hence, women with both of these diseases may be identified in the future. Because most of the HIV-positive and HIV-indeterminate lung cancer patients were smokers,1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar, 13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar, 21Sridhar KS Raub Jr, WA Present and past smoking history and other predisposing factors in 100 lung cancer patients.Chest. 1992; 101: 1925Abstract Full Text Full Text PDF Scopus (27) Google Scholar tobacco smoking appears to be the major carcinogen in both groups. The occurrence of other malignant neoplasms in HIV-infected patients has been postulated to be due to immunosuppression, use of recreational drugs, cytomegalovirus, and Epstein-Barr virus infections.22Groopman JE Broder S Cancer in AIDS and other immunodeficiency states.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 1953-1959Google Scholar However, none of the above factors, except recreational drugs have been implicated as a carcinogen for lung cancer.13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar, 21Sridhar KS Raub Jr, WA Present and past smoking history and other predisposing factors in 100 lung cancer patients.Chest. 1992; 101: 1925Abstract Full Text Full Text PDF Scopus (27) Google Scholar, 23Ferguson RP Hasson J Walker S Metastatic lung cancer in young marijuana smoker.JAMA. 1989; 261: 41-42Crossref PubMed Scopus (21) Google Scholar Marijuana smoke is rich in carcinogens24Tashkin DP Calvarese BM Simmons MS Shapiro BJ Respiratory status of 74 habitual marijuana smokers.Chest. 1980; 78: 699-706Crossref PubMed Scopus (64) Google Scholar and marijuana use has been noted in young patients with lung cancer.23Ferguson RP Hasson J Walker S Metastatic lung cancer in young marijuana smoker.JAMA. 1989; 261: 41-42Crossref PubMed Scopus (21) Google Scholar, 25Sridhar KS Pot smoking and HIV infection in young lung cancer patients.Chest. 1991; 100: 131SAbstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Young patients with lung cancer were reported to have a shorter survival in some series,13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar but this was not confirmed by our data.1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar The series of HIV-positive lung cancer patients reported herein is the largest to date. The survival of the control group of HIV-indeterminate lung cancer patients was marginally better than expected1Sridhar KS Raub W Duncan RC Hilsenbeck S Richman SP Lung carcinoma in 1336 patients.Am J Clin Oncol. 1991; 14: 496-508Crossref PubMed Scopus (16) Google Scholar, 2Boring CC Squires TS Tong T Cancer statistics.CA. 1991; 42: 19-36Google Scholar, 13Minna JD Pass H Clatstein E Ihde DC Cancer of the lung.in: DeVita VT Hellman S Rosenberg SA Cancer, principles and practice of oncology. 3rd ed. JB Lippincott Co, Philadelphia1989: 591-688Google Scholar: 45 percent (±9 percent) at one year, 37 percent (±9 percent) at two years, and 25 percent (±8 percent) at three to five years. The short survival of HIV-positive lung cancer patients and the respiratory failure as a terminal event may be related to rapidly progressive lung cancer, poor tolerance, and noncompliance with anticancer treatments and intercurrent opportunistic infections. There are no long-term survivors in HIV-positive lung cancer patients reported so far. Future studies on the clinical course and autopsy may clarify the reasons for respiratory failure and short survival in patients with HIV infection and lung cancer. Respiratory morbidity may be minimized by aggressive local treatment of lung cancer and therapy of opportunistic infections. In the rare patient with HIV infection, CDC group 1 or 2, early stage non–small-cell lung cancer, and good physiologic and respiratory status, surgical resection may be indicated in an attempt to achieve long-term survival. Linda Vega typed the manuscript. Lung Cancer: An HIV-related Neoplasm or a Coincidental Finding?CHESTVol. 102Issue 6PreviewIndex AIDS-defining neoplasms since 1985 include Kaposi's sarcoma, primary central nervous system lymphoma, and non-Hodgkin's lymphoma. The incidence of the latter two neoplasms is sharply on the rise. All three of these AIDS-defining neoplasms are characterized by higher-grade lesions, more advanced stage, and shorter survival when compared with similar tumors in patients not infected with human immunodeficiency virus (HIV). As we enter the second decade of the HIV epidemic, it is apparent that other solid tumors are seen in these patients as well. Full-Text PDF
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