Stebbing Justin, Krown Susan E, Bower Mark, Batra Anu, Slater Sarah, Serraino Diego, Dezube Bruce J, Dhir Aruna A, Pantanowitz Liron
Department of Medical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, First Floor, East Wing, Fulham Palace Road, London W6 8RF, England.
Arch Intern Med. 2010 Jan 25;170(2):203-7. doi: 10.1001/archinternmed.2009.490.
As human immunodeficiency virus (HIV)-infected individuals are living longer, non-AIDS-defining cancers are becoming increasingly recognized. Primary esophageal tumors in people living with HIV have seldom been reported. We sought to document patient, virologic, and tumor characteristics and clinical outcomes in this patient group.
International physicians involved in the care of AIDS-defining and non-AIDS-defining cancers accrued cases of primary esophageal malignant neoplasms in HIV-infected individuals. Patient demographics, HIV status, cancer risk factors, esophageal tumor characteristics, treatment, and outcomes were analyzed.
A total of 19 patients with primary adenocarcinoma and/or squamous cell carcinoma of the esophagus were identified. The median age was 48 years (range, 35-69 years) and the median CD4 lymphocyte count measured 376 cells/microL (range, 42 to >1000 cells/microL) (to convert to x10(9)/L, multiply by 0.001). The majority of patients were men with a history of smoking or considerable alcohol consumption. Prior esophageal disease (reflux, peptic ulcers, and achalasia) was reported in almost half of all patients. Seven patients (37%) underwent surgical resection, 11 (58%) received fluorouracil-based chemotherapy, and 7 (37%) underwent radiotherapy; survival correlated with stage at cancer presentation. While the majority of patients died, only 5 deaths (26%) were attributed to progression of esophageal carcinoma.
Primary esophageal carcinoma is another non-AIDS-defining cancer associated with moderate immunosuppression and lifestyle habits including tobacco and alcohol use. The biological behavior, treatment, and outcome of HIV-related esophageal cancer appear similar to the general population with this disease; the same screening and risk moderation strategies are likely to apply.
随着人类免疫缺陷病毒（HIV）感染个体的寿命延长，非艾滋病定义性癌症越来越受到关注。HIV感染者的原发性食管肿瘤鲜有报道。我们试图记录该患者群体的患者、病毒学、肿瘤特征及临床结局。
参与艾滋病定义性和非艾滋病定义性癌症治疗的国际医生收集HIV感染个体原发性食管恶性肿瘤病例。分析患者人口统计学、HIV状态、癌症风险因素、食管肿瘤特征、治疗及结局。
共识别出19例食管原发性腺癌和/或鳞状细胞癌患者。中位年龄为48岁（范围35 - 69岁），CD4淋巴细胞计数中位数为376个/微升（范围42至>1000个/微升）（换算为x10(9)/L时，乘以0.001）。大多数患者为有吸烟史或大量饮酒史的男性。几乎一半的患者报告有既往食管疾病（反流、消化性溃疡和贲门失弛缓症）。7例患者（37%）接受了手术切除，11例（58%）接受了以氟尿嘧啶为基础的化疗，7例（37%）接受了放疗；生存与癌症初诊时的分期相关。虽然大多数患者死亡，但只有5例死亡（26%）归因于食管癌进展。
原发性食管癌是另一种与中度免疫抑制及包括吸烟和饮酒在内的生活方式相关的非艾滋病定义性癌症。HIV相关食管癌的生物学行为、治疗及结局与患该病的普通人群相似；可能适用相同的筛查和风险控制策略。
