头颈部鳞状细胞癌在 HIV 感染患者中的流行病学。
Epidemiology of head and neck squamous cell cancer among HIV-infected patients.
机构信息
*Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, MI; ‡Department of Head and Neck Medical Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX; §Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA; ‖Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY; ¶Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; #Department of Otolaryngology/Head and Neck Surgery, Johns Hopkins University, Baltimore, MD; **Cancer Biology Program, University of Michigan, Ann Arbor, MI; ††Department of Biostatistics, University of Texas M. D. Anderson Cancer Center, Houston, TX; §§Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA; and ‖‖Department of Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
出版信息
J Acquir Immune Defic Syndr. 2014 Apr 15;65(5):603-10. doi: 10.1097/QAI.0000000000000083.
BACKGROUND
HIV-infected individuals have a higher incidence of head and neck cancer (HNC).
METHODS
Case series of 94 HIV-infected HNC patients (HIV-HNC) at 6 tertiary care referral centers in the US between 1991 and 2011. Clinical and risk factor data were abstracted from the medical record. Risk factors for survival were analyzed using Cox proportional hazard models. Human papillomavirus (HPV) and p16 testing was performed in 46 tumors. Findings were compared with Surveillance Epidemiology and End Results HNC (US-HNC) data.
RESULTS
This study represents the largest HIV-HNC series reported to date. HIV-HNC cases were more likely than US-HNC to be male (91% vs. 68%), younger (median age, 50 vs. 62 years), nonwhite (49% vs. 18%), and current smokers (61% vs. 18%). Median HIV-HNC survival was not appreciably lower than US-HNC survival (63 vs. 61 months). At diagnosis, most cases were currently on highly active antiretroviral therapy (77%) but had detectable HIV viremia (99%), and median CD4 was 300 cells per microliter (interquartile range = 167-500). HPV was detected in 30% of HIV-HNC and 64% of HIV-oropharyngeal cases. Median survival was significantly lower among those with CD4 counts ≤200 than >200 cells per microliter at diagnosis (16.1 vs. 72.8 months, P < 0.001). In multivariate analysis, poorer survival was associated with CD4 <100 cells per microliter [adjusted hazard ratio (aHR) = 3.09, 95% confidence interval (CI): 1.15 to 8.30], larynx/hypopharynx site (aHR = 3.54, 95% CI: 1.34 to 9.35), and current tobacco use (aHR = 2.54, 95% CI: 0.96 to 6.76).
CONCLUSIONS
Risk factors for the development of HNC in patients with HIV infection are similar to the general population, including both HPV-related and tobacco/alcohol-related HNC.
背景
HIV 感染者的头颈部癌症（HNC）发病率较高。
方法
本研究为美国 6 家三级转诊中心 1991 年至 2011 年间的 94 例 HIV 感染合并头颈部癌症患者（HIV-HNC）的病例系列研究。从病历中提取临床和危险因素数据。使用 Cox 比例风险模型分析生存的危险因素。对 46 例肿瘤进行人乳头瘤病毒（HPV）和 p16 检测。研究结果与监测、流行病学和最终结果头颈部癌症（美国-HNC）数据进行了比较。
结果
本研究是迄今为止报告的最大的 HIV-HNC 系列研究。与美国-HNC 相比，HIV-HNC 患者更可能为男性（91% vs. 68%）、年龄更小（中位年龄 50 岁 vs. 62 岁）、非白种人（49% vs. 18%）和当前吸烟者（61% vs. 18%）。HIV-HNC 的中位生存时间与美国-HNC 生存时间无显著差异（63 个月 vs. 61 个月）。在诊断时，大多数患者目前正在接受高效抗逆转录病毒治疗（77%），但存在可检测的 HIV 病毒血症（99%），中位 CD4 为 300 个细胞/微升（四分位间距=167-500）。在 HIV-HNC 中，HPV 的检出率为 30%，在 HIV 口咽癌中为 64%。与诊断时 CD4 计数>200 个细胞/微升的患者相比，CD4 计数≤200 个细胞/微升的患者中位生存时间显著缩短（16.1 个月 vs. 72.8 个月，P<0.001）。多变量分析显示，CD4<100 个细胞/微升（调整后的危险比[aHR]=3.09，95%置信区间[CI]：1.15 至 8.30）、喉/下咽部位（aHR=3.54，95%CI：1.34 至 9.35）和当前吸烟（aHR=2.54，95%CI：0.96 至 6.76）与较差的生存相关。
结论
HIV 感染者发生 HNC 的危险因素与普通人群相似，包括 HPV 相关和烟草/酒精相关的 HNC。
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