意大利艾滋病患者癌症存活情况，1986-2005 年：基于人群的估计。
Survival after cancer in Italian persons with AIDS, 1986-2005: a population-based estimation.
机构信息
*Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, Italy; †Istituto Superiore di Sanità, Rome, Italy; ‡International Agency for Research on Cancer, Lyon, France; §AIRTUM database, Florence, Italy; ‖Tuscany Cancer Registry, UO di epidemiologia clinica e descrittiva, Istituto per lo studio e la prevenzione oncologica, Florence, Italy; ¶Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; #Department of Epidemiology, INMI "L Spallanzani" IRCCS, Rome, Italy; **Romagna Cancer Registry, Cancer Institute of Romagna IRCCS, Meldola, Italy; ††Piedmont Cancer Registry, Oncology Prevention Center (CPO), Torino, Italy; ‡‡Registro Tumori Regione Liguria, IRCSS Azienda Università Ospedale San Martino-IST Istituto nazionale ricerca sul cancro e Dipartimento di scienze della salute, Genoa University, Genoa, Italy; §§Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS, Padua, Italy; ‖‖Milan Cancer Registry, Milan Health Authority, Epidemiology Unit, Milan, Italy; ¶¶Lombardia Cancer Registry, Varese Province, National Cancer Institute, Milan, Italy; ##Modena Cancer Registry, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy; ***Ferrara Cancer Registry, Ferrara University, Ferrara, Italy; †††Brescia Health Unit, Cancer Registry, Brescia, Italy; ‡‡‡S.C. Statistica, qualità e studi clinici IRCCS, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; §§§Parma Province Cancer Registry, University Hospital Parma, Parma, Italy; ‖‖‖Umbria Cancer Registry, Department of Medical and Surgical Specialties, and Public Health, Section of Public Health, Perugia University, Perugia, Italy; ¶¶¶Cancer Registry of Sassari, Sassari, Italy; ###Registro Tumori della Provincia di Trento, Servizio di Epidemiologia Clinica e Valutativa, Trento, Italy; ****Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy; †††
出版信息
J Acquir Immune Defic Syndr. 2014 Aug 1;66(4):428-35. doi: 10.1097/QAI.0000000000000184.
BACKGROUND
Cancer survival in persons with AIDS (PWA) after introduction of antiretroviral therapies remains poorly characterized. The aim is to provide population-based estimates of cancer survival, overall and for the most important cancer types in PWA, and a comparison with persons without AIDS (non-PWA) affected by the same cancer.
METHODS
PWA with cancer at AIDS diagnosis or thereafter were individually matched with non-PWA by type of cancer, sex, age, year of diagnosis, area of living, and, for lymphomas, histological subtype. Five-year observed survival and hazard ratios (HRs) of death in PWA versus non-PWA with 95% confidence intervals (CIs) were estimated.
RESULTS
We included 2262 Italian PWA and 4602 non-PWA with cancer diagnosed during 1986-2005. Between 1986 and 1995, and 1996 and 2005, 5-year survival for all cancers in PWA improved from 12% to 41% and the corresponding HR versus non-PWA decreased from 5.1 (95% CI: 4.3 to 6.1) to 2.9 (95% CI: 2.6 to 3.3). During 1996-2005, HRs were 2.0 (95% CI: 1.4 to 2.9) for Kaposi sarcoma, 3.4 (95% CI: 2.9 to 4.1) for non-Hodgkin lymphoma, and 2.4 (95% CI: 1.4 to 4.0) for cervical cancer. HRs were 2.5 (95% CI: 2.1 to 3.1) for all non-AIDS-defining cancers, 5.9 (95% CI: 3.1 to 11.2) for Hodgkin lymphoma, and 7.3 (95% CI: 2.8 to 19.2) for nonmelanoma skin cancer. A ≤3-fold survival difference was found for cancers of the stomach, liver, anus, lung, brain, and the most aggressive lymphoma subtypes.
CONCLUSIONS
The persisting, although narrowing, gap in cancer survival between PWA and non-PWA indicates the necessity of enhancing therapeutic approaches, so that PWA can be provided the same chances of survival observed in the general population, and improving cancer prevention and screening.
背景
在引入抗逆转录病毒疗法后，艾滋病患者（PWA）的癌症生存情况仍不明确。本研究旨在提供基于人群的癌症生存数据，包括 PWA 总体和最重要的癌症类型的生存情况，并与患有相同癌症的非艾滋病患者（非 PWA）进行比较。
方法
根据癌症类型、性别、年龄、诊断年份、居住地区以及淋巴瘤的组织学亚型，对 AIDS 诊断时或之后患有癌症的 PWA 进行个体匹配，并与非 PWA 进行匹配。使用 95%置信区间（CI）估计 5 年观察生存率和 PWA 与非 PWA 之间的死亡风险比（HR）。
结果
我们纳入了 2262 名意大利 PWA 和 4602 名非 PWA，他们在 1986 年至 2005 年间被诊断患有癌症。在 1986 年至 1995 年和 1996 年至 2005 年期间，PWA 所有癌症的 5 年生存率从 12%提高到 41%，相应的非 PWA 与 PWA 相比的 HR 从 5.1（95%CI：4.3 至 6.1）降至 2.9（95%CI：2.6 至 3.3）。在 1996 年至 2005 年期间，Kaposi 肉瘤的 HR 为 2.0（95%CI：1.4 至 2.9），非霍奇金淋巴瘤为 3.4（95%CI：2.9 至 4.1），宫颈癌为 2.4（95%CI：1.4 至 4.0）。非艾滋病定义的所有癌症的 HR 为 2.5（95%CI：2.1 至 3.1），霍奇金淋巴瘤为 5.9（95%CI：3.1 至 11.2），非黑色素瘤皮肤癌为 7.3（95%CI：2.8 至 19.2）。在胃癌、肝癌、肛门癌、肺癌、脑癌和侵袭性最强的淋巴瘤亚型中，发现癌症生存率的差异不超过 3 倍。
结论
PWA 与非 PWA 之间癌症生存差距虽然在缩小，但仍然存在，这表明有必要加强治疗方法，以使 PWA 能够获得与普通人群相同的生存机会，并改善癌症预防和筛查。
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