Ferreira Mariana P, Coghill Anna E, Chaves Claudia B, Bergmann Anke, Thuler Luiz C, Soares Esmeralda A, Pfeiffer Ruth M, Engels Eric A, Soares Marcelo A
aPrograma de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil bDivision of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland, USA cSeção de Ginecologia Oncológica dPrograma de Carcinogênese Molecular ePrograma de Pesquisa Clínica, Instituto Nacional de Câncer, Rio de Janeiro, Rio de Janeiro, Brazil.
AIDS. 2017 Feb 20;31(4):523-531. doi: 10.1097/QAD.0000000000001367.
We assessed mortality, treatment response, and relapse among HIV-infected and HIV-uninfected women with cervical cancer in Rio de Janeiro, Brazil.
Cohort study of 87 HIV-infected and 336 HIV-uninfected women with cervical cancer.
Patients at the Brazilian National Institute of Cancer (2001-2013) were matched on age, calendar year of diagnosis, clinical stage, and tumor histology. Staging and treatment with surgery, radiotherapy, and/or chemotherapy followed international guidelines. We used a Markov model to assess responses to initial therapy, and Cox models for mortality and relapse after complete response (CR).
Among 234 deaths, most were from cancer (82% in HIV-infected vs. 93% in HIV-uninfected women); only 9% of HIV-infected women died from AIDS. HIV was not associated with mortality during initial follow-up but was associated more than 1-2 years after diagnosis [overall mortality: stage-adjusted hazard ratio 2.02, 95% confidence interval (CI) 1.27-3.22; cancer-specific mortality: 4.35, 1.86-10.2]. Among 222 patients treated with radiotherapy, HIV-infected had similar response rates to initial cancer therapy as HIV-uninfected women (hazard ratio 0.98, 95% CI 0.58-1.66). However, among women who were treated and had a CR, HIV was associated with elevated risk of subsequent relapse (hazard ratio 3.60, 95% CI 1.86-6.98, adjusted for clinical stage).
Among women with cervical cancer, HIV infection was not associated with initial treatment response or early mortality, but relapse after attaining a CR and late mortality were increased in those with HIV. These results point to a role for an intact immune system in control of residual tumor burden among treated cervical cancer patients.
我们评估了巴西里约热内卢感染HIV和未感染HIV的宫颈癌女性的死亡率、治疗反应及复发情况。
对87例感染HIV和336例未感染HIV的宫颈癌女性进行队列研究。
巴西国立癌症研究所（2001 - 2013年）的患者在年龄、诊断年份、临床分期和肿瘤组织学方面进行匹配。手术、放疗和/或化疗的分期及治疗遵循国际指南。我们使用马尔可夫模型评估初始治疗反应，使用Cox模型评估完全缓解（CR）后的死亡率和复发情况。
在234例死亡病例中，大多数死于癌症（感染HIV的女性中占82%，未感染HIV的女性中占93%）；仅9%的感染HIV女性死于艾滋病。HIV在初始随访期间与死亡率无关，但在诊断后1 - 2年以上与之相关[总死亡率：分期调整后的风险比为2.02，95%置信区间（CI）为1.27 - 3.22；癌症特异性死亡率：4.35，1.86 - 10.2]。在222例接受放疗的患者中，感染HIV的女性对初始癌症治疗的反应率与未感染HIV的女性相似（风险比为0.98，95%CI为0.58 - 1.66）。然而，在接受治疗且达到CR的女性中，HIV与随后复发风险升高相关（风险比为3.60，95%CI为1.86 - 6.98，经临床分期调整）。
在宫颈癌女性中，HIV感染与初始治疗反应或早期死亡率无关，但达到CR后的复发率及晚期死亡率在感染HIV的女性中有所增加。这些结果表明完整的免疫系统在控制接受治疗的宫颈癌患者残余肿瘤负荷中发挥作用。
