人类免疫缺陷病毒感染作为非小细胞肺癌手术患者的预后因素。
Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer.
机构信息
Department of Oncology, Johns Hopkins School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
出版信息
Ann Thorac Surg. 2012 Feb;93(2):405-12. doi: 10.1016/j.athoracsur.2011.11.012.
BACKGROUND
The purpose of this study was to assess the effect of human immunodeficiency virus (HIV) infection on postoperative survival among non-small cell lung cancer (NSCLC) patients.
METHODS
A retrospective cohort study compared 22 HIV-infected lung cancer patients to 2,430 lung cancer patients with HIV-unspecified status who underwent resection at Johns Hopkins Hospital from 1985 to 2009. Subcohort comparative analyses were performed using individual matching methods.
RESULTS
Thirty-day mortality rates did not differ between HIV-infected and HIV-unspecified patients. Survival rates for HIV-infected lung cancer patients were significantly shorter than for HIV-unspecified patients (median, 26 versus 48 months; p=0.001). After adjustment, the relative hazard of mortality among HIV-infected NSCLC patients was more than threefold that of HIV-unspecified patients (adjusted hazard ratio, 3.08; 95% confidence interval: 1.85 to 5.13). When additional surgical characteristics were modeled in a matched subcohort, the association remained statistically significant (adjusted hazard ratio, 2.31; 95% confidence interval: 1.11 to 4.81). Moreover, HIV-infected lung cancer patients with CD4 counts less than 200 cells/mm3 had shortened median survival compared with patients whose CD4 counts were 200 cells/mm3 or greater (8 versus 40 months; p=0.031). Postoperative pulmonary and infectious complications were also elevated in the HIV-infected group (p=0.001 and p<0.001, respectively). After surgery, median time to cancer progression was shorter among HIV-infected patients (20.4 months) versus HIV-unspecified patients (p=0.061).
CONCLUSIONS
The HIV-infected NSCLC patients have more postoperative complications, rapid progression to disease recurrence, and poorer postoperative survival. Optimizing immune status before surgery and careful patient selection based on diffusion capacity of lung for carbon monoxide may improve patient outcomes.
背景
本研究旨在评估人类免疫缺陷病毒（HIV）感染对非小细胞肺癌（NSCLC）患者术后生存的影响。
方法
采用回顾性队列研究，比较了 1985 年至 2009 年在约翰霍普金斯医院接受手术的 22 例 HIV 感染肺癌患者和 2430 例 HIV 未明确状态的肺癌患者。采用个体匹配方法进行亚组比较分析。
结果
HIV 感染组和 HIV 未明确组的 30 天死亡率无差异。HIV 感染肺癌患者的生存率明显短于 HIV 未明确组（中位数分别为 26 个月和 48 个月；p=0.001）。调整后，HIV 感染 NSCLC 患者的死亡相对危险度是 HIV 未明确患者的三倍以上（调整后的危险比为 3.08；95%置信区间：1.85 至 5.13）。在匹配亚组中进一步纳入手术特征模型后，相关性仍具有统计学意义（调整后的危险比为 2.31；95%置信区间：1.11 至 4.81）。此外，CD4 计数<200 个细胞/mm3 的 HIV 感染肺癌患者的中位生存期短于 CD4 计数≥200 个细胞/mm3 的患者（8 个月与 40 个月；p=0.031）。HIV 感染组的术后肺部和感染并发症也较高（p=0.001 和 p<0.001）。手术后，HIV 感染患者的癌症进展中位时间更短（20.4 个月）与 HIV 未明确患者（p=0.061）。
结论
HIV 感染的 NSCLC 患者术后并发症更多，疾病复发进展更快，术后生存更差。手术前优化免疫状态，并根据一氧化碳扩散能力对患者进行仔细选择，可能会改善患者的预后。
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