TREAT Asia HIV Observational Database（TAHOD）中的癌症：风险因素的回顾性分析。
Cancers in the TREAT Asia HIV Observational Database (TAHOD): a retrospective analysis of risk factors.
机构信息
National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW, Australia.
出版信息
J Int AIDS Soc. 2010 Dec 10;13:51. doi: 10.1186/1758-2652-13-51.
BACKGROUND
This retrospective survey describes types of cancers diagnosed in HIV-infected subjects in Asia, and assesses risk factors for cancer in HIV-infected subjects using contemporaneous HIV-infected controls without cancer.
METHODS
TREAT Asia HIV Observational Database (TAHOD) sites retrospectively reviewed clinic medical records to determine cancer diagnoses since 2000. For each diagnosis, the following data were recorded: date, type, stage, method of diagnosis, demographic data, medical history, and HIV-related information. For risk factor analyses, two HIV-infected control subjects without cancer diagnoses were also selected. Cancers were grouped as AIDS-defining cancers (ADCs), and non-ADCs. Non-ADCs were further categorized as being infection related (NADC-IR) and unrelated (NADC-IUR).
RESULTS
A total of 617 patients were included in this study: 215 cancer cases and 402 controls from 13 sites. The majority of cancer cases were male (71%). The mean age (SD) for cases was 39 (10.6), 46 (11.5) and 44 (13.7) for ADCs, NADC-IURs and NADCs-IR, respectively. The majority (66%) of cancers were ADCs (16% Kaposi sarcoma, 40% non-Hodgkin's lymphoma, and 9% cervical cancer). The most common NADCs were lung (6%), breast (5%) and hepatocellular carcinoma and Hodgkin's lymphoma (2% each). There were also three (1.4%) cases of leiomyosarcoma reported in this study. In multivariate analyses, individuals with CD4 counts above 200 cells/mm3 were approximately 80% less likely to be diagnosed with an ADC (p < 0.001). Older age (OR: 1.39, p = 0.001) and currently not receiving antiretroviral treatment (OR: 0.29, p = 0.006) were independent predictors of NADCs overall, and similarly for NADCs-IUR. Lower CD4 cell count and higher CDC stage (p = 0.041) were the only independent predictors of NADCs-IR.
CONCLUSIONS
The spectrum of cancer diagnoses in the Asia region currently does not appear dissimilar to that observed in non-Asian HIV populations. One interesting finding was the cases of leiomyosarcoma, a smooth-muscle tumour, usually seen in children and young adults with AIDS, yet overall quite rare. Further detailed studies are required to better describe the range of cancers in this region, and to help guide the development of screening programmes.
背景
本回顾性研究描述了亚洲地区 HIV 感染者所患癌症的类型，并通过同期未患有癌症的 HIV 感染者对照评估了 HIV 感染者癌症的风险因素。
方法
TREAT Asia HIV 观察性数据库（TAHOD）的各研究点回顾性审查了临床病历，以确定自 2000 年以来的癌症诊断情况。对于每种诊断，记录了以下数据：日期、类型、分期、诊断方法、人口统计学数据、病史和 HIV 相关信息。对于风险因素分析，还选择了两名未患有癌症诊断的 HIV 感染者对照。将癌症分为艾滋病定义性癌症（ADC）和非艾滋病定义性癌症（NADC）。非艾滋病定义性癌症进一步分为感染相关（NADC-IR）和非感染相关（NADC-IUR）。
结果
这项研究共纳入了 617 名患者：来自 13 个研究点的 215 例癌症病例和 402 例对照。大多数癌症病例为男性（71%）。病例组的平均年龄（标准差）分别为 39（10.6）、46（11.5）和 44（13.7），分别为 ADC、NADC-IUR 和 NADCs-IR。大多数癌症（66%）为 ADC（16%卡波西肉瘤、40%非霍奇金淋巴瘤和 9%宫颈癌）。最常见的 NADCs 为肺癌（6%）、乳腺癌（5%）和肝癌和霍奇金淋巴瘤（2%）。本研究还报告了三例（1.4%）平滑肌肉瘤病例。多变量分析显示，CD4 计数高于 200 个细胞/mm3 的个体被诊断为 ADC 的可能性低 80%（p<0.001）。年龄较大（OR：1.39，p=0.001）和未接受抗逆转录病毒治疗（OR：0.29，p=0.006）是 NADCs 总体的独立预测因素，对 NADCs-IUR 也同样如此。较低的 CD4 细胞计数和较高的 CDC 分期（p=0.041）是 NADCs-IR 的唯一独立预测因素。
结论
目前亚洲地区癌症诊断的范围似乎与非亚洲 HIV 人群中的情况相似。一个有趣的发现是平滑肌肉瘤病例，这是一种通常在 AIDS 患儿和年轻成人中见到的平滑肌肿瘤，但总体来说非常罕见。需要进一步进行详细研究，以更好地描述该地区的癌症范围，并帮助指导筛查计划的制定。
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