Shebl Fatma M, Engels Eric A, Goedert James J
Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Rockville, Maryland, USA.
AIDS Res Hum Retroviruses. 2012 Sep;28(9):994-99. doi: 10.1089/AID.2011.0185. Epub 2012 Feb 2.
Because mucosal inflammation contributes to colorectal carcinogenesis, we studied the impact of intestinal infections on risk of this malignancy among people with AIDS (PWA). Using the population-based HIV/AIDS Cancer Match, which includes approximately half of all PWA in the United States, the cancer registries ascertained colorectal cancers (ICD-O3 codes C180-C189, C199, C209, and C260). During 4-120 months after AIDS onset, risk of cancer occurring after AIDS-defining intestinal infections (considered as time-dependent exposures) was estimated with hazard ratios (HR) and 95% confidence intervals (CI) calculated by Cox regression. Analyses included cancers overall and by histology and anatomic site. After excluding 118 squamous cell rectal cancers (possible anal cancers), we analyzed 320 incident colorectal cancer cases that occurred among 471,909 PWA. Colorectal cancer risk was marginally elevated following cryptosporidiosis (HR=2.08, 95% CI=0.93-4.70, p=0.08) and mucocutaneous herpes (HR=1.69, 95% CI=0.97-2.95, p=0.07) but not with Pneumocystis pneumonia (HR=0.79, 95% CI=0.57-1.10). Cryptosporidiosis was associated with rare colon squamous cell carcinoma [N=8, HR=13, 95% CI=1.5-110] and uncommon histologies [HR=4.4, 95% CI=1.1-18, p=0.04], but it was not associated with colorectal adenocarcinoma (N=269, HR=1.3, 95% CI=0.4-3.9, p=0.70). Mucocutaneous herpes was associated with colon squamous cell carcinoma (HR=13, 95% CI=2.4-67, p=0.003) but not with colorectal adenocarcinoma (HR=1.3, 95% CI=0.6-2.6, p=0.52) or uncommon histologies (HR=2.5, 95% CI=0.8-8.2, p=0.13). Colon squamous cell carcinoma risk was significantly elevated among PWA who had cryptosporidiosis or mucocutaneous herpes. These findings might suggest that HPV or inflammation from other infection may contribute to carcinogenesis.
由于黏膜炎症会促进结直肠癌的发生，我们研究了肠道感染对艾滋病患者（PWA）患这种恶性肿瘤风险的影响。我们使用了基于人群的HIV/AIDS癌症匹配数据库，该数据库涵盖了美国约一半的艾滋病患者，癌症登记处确定了结直肠癌（ICD - O3编码为C180 - C189、C199、C209和C260）。在艾滋病发病后的4 - 120个月内，通过Cox回归计算风险比（HR）和95%置信区间（CI），来估计艾滋病定义的肠道感染（视为时间依赖性暴露）后发生癌症的风险。分析包括总体癌症以及按组织学和解剖部位分类的癌症。在排除118例鳞状细胞直肠癌（可能为肛管癌）后，我们分析了471,909例艾滋病患者中发生的320例结直肠癌新发病例。隐孢子虫病（HR = 2.08，95% CI = 0.93 - 4.70，p = 0.08）和皮肤黏膜疱疹（HR = 1.69，95% CI = 0.97 - 2.95，p = 0.07）后结直肠癌风险略有升高，但卡氏肺孢子虫肺炎后未升高（HR = 0.79，95% CI = 0.57 - 1.10）。隐孢子虫病与罕见的结肠鳞状细胞癌相关[N = 8，HR = 13，95% CI = 1.5 - 110]和不常见的组织学类型相关[HR = 4.4，95% CI = 1.1 - 18，p = 0.04]，但与结直肠腺癌无关（N = 269，HR = 1.3，95% CI = 0.4 - 3.9，p = 0.70）。皮肤黏膜疱疹与结肠鳞状细胞癌相关（HR = 13，95% CI = 2.4 - 67，p = 0.003），但与结直肠腺癌无关（HR = 1.3，95% CI = 0.6 - 2.6，p = 0.52）或不常见的组织学类型无关（HR = 2.5，95% CI = 0.8 - 8.2，p = 0.13）。患有隐孢子虫病或皮肤黏膜疱疹的艾滋病患者中结肠鳞状细胞癌风险显著升高。这些发现可能表明人乳头瘤病毒（HPV）或其他感染引起的炎症可能促进癌症发生。
