Department of Radiation Oncology, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
AIDS. 2013 Jan 28;27(3):459-68. doi: 10.1097/QAD.0b013e32835ad56e.
HIV-infected people have elevated risk for lung cancer and higher mortality following cancer diagnosis than HIV-uninfected individuals. It is unclear whether HIV-infected individuals with lung cancer receive similar cancer treatment as HIV-uninfected individuals.
DESIGN/METHODS: We studied adults more than 18 years of age with lung cancer reported to the Texas Cancer Registry (N = 156 930) from 1995 to 2009. HIV status was determined by linkage with the Texas enhanced HIV/AIDS Reporting System. For nonsmall cell lung cancer (NSCLC) cases, we identified predictors of cancer treatment using logistic regression. We used Cox regression to evaluate effects of HIV and cancer treatment on mortality.
Compared with HIV-uninfected lung cancer patients (N = 156 593), HIV-infected lung cancer patients (N = 337) were more frequently young, non-Hispanic black, men, and with distant stage disease. HIV-infected NSCLC patients less frequently received cancer treatment than HIV-uninfected patients [60.3 vs. 77.5%; odds ratio 0.39, 95% confidence interval (CI) 0.30-0.52, after adjustment for diagnosis year, age, sex, race, stage, and histologic subtype]. HIV infection was associated with higher lung cancer-specific mortality (hazard ratio 1.34, 95% CI 1.15-1.56, adjusted for demographics and tumor characteristics). Inclusion of cancer treatment in adjusted models slightly attenuated the effect of HIV on lung cancer-specific mortality (hazard ratio 1.25; 95% CI 1.06-1.47). Also, there was a suggestion that HIV was more strongly associated with mortality among untreated than among treated patients (adjusted hazard ratio 1.32 vs. 1.16, P-interaction = 0.34).
HIV-infected NSCLC patients were less frequently treated for lung cancer than HIV-uninfected patients, which may have affected survival.
与未感染 HIV 的个体相比，HIV 感染者在确诊癌症后肺癌风险升高，且癌症死亡率更高。目前尚不清楚 HIV 感染者肺癌患者是否接受与未感染 HIV 的个体相似的癌症治疗。
方法/设计：我们研究了 1995 年至 2009 年期间向德克萨斯癌症登记处（N = 156930）报告的年龄在 18 岁以上的肺癌成年人。通过与德克萨斯州强化艾滋病毒/艾滋病报告系统的关联确定 HIV 状态。对于非小细胞肺癌（NSCLC）病例，我们使用逻辑回归确定癌症治疗的预测因素。我们使用 Cox 回归评估 HIV 和癌症治疗对死亡率的影响。
与未感染 HIV 的肺癌患者（N = 156593）相比，感染 HIV 的肺癌患者（N = 337）更年轻、非西班牙裔黑人、男性和远处转移疾病。感染 HIV 的 NSCLC 患者接受癌症治疗的比例低于未感染患者[60.3%比 77.5%；比值比 0.39，95%置信区间（CI）0.30-0.52，在调整诊断年份、年龄、性别、种族、分期和组织学亚型后]。HIV 感染与肺癌特异性死亡率升高相关（调整后危险比 1.34，95%CI 1.15-1.56，调整后人口统计学和肿瘤特征）。在调整模型中纳入癌症治疗后，HIV 对肺癌特异性死亡率的影响略有减弱（调整后危险比 1.25；95%CI 1.06-1.47）。此外，有迹象表明，在未治疗患者中，HIV 与死亡率的相关性强于在治疗患者中（调整后危险比 1.32 比 1.16，P 交互=0.34）。
与未感染 HIV 的患者相比，HIV 感染的 NSCLC 患者接受肺癌治疗的频率较低，这可能影响了生存。
