Tanaka Luana F, Latorre Maria do Rosário D O, Gutierrez Eliana B, Curado Maria P, Dal Maso Luigino, Herbinger Karl-Heinz, Froeschl Guenter, Heumann Christian
Center for International Health, Medical Center of the University of Munich (LMU), Munich, Germany.
Department of Epidemiology, School of Public Health, University of São Paulo, São Paulo, Brazil.
Int J Cancer. 2018 Feb 1;142(3):524-533. doi: 10.1002/ijc.31081. Epub 2017 Oct 16.
Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.
发达国家已对艾滋病患者（PWA）的癌症生存率进行了描述，但发展中国家缺乏相关数据。本研究的目的是评估巴西圣保罗PWA癌症诊断后的生存率，并将其与非艾滋病患者（非PWA）进行比较。在圣保罗基于人群的癌症登记处（PBCR-SP）数据库和圣保罗艾滋病登记处（SINAN）之间进行了概率性记录链接，以识别患癌的PWA。为作比较，从PBCR-SP中按癌症部位/类型、性别、年龄和时期对非PWA进行频率匹配。使用Cox比例风险模型估计按匹配变量分层的风险比（HR）。共有1294名PWA（20例有两个原发部位肿瘤的患者）纳入了特定部位/类型分析。艾滋病相关定义癌症（ADC）占评估病例的51.9%。PWA的所有癌症5年总生存率为49.4%，而非PWA为72.7%（HR = 2.64；95%CI = 2.39 - 2.91）。ADC（HR = 2.93；95%CI = 2.49 - 3.45）和非ADC（HR = 2.51；95%CI = 2.21 - 2.84）的PWA生存率均受损，包括膀胱癌（HR = 8.11；95%CI = 2.09 - 31.52）、肺癌（HR = 2.93；95%CI = 1.97 - 4.36）和肛门癌（HR = 2.53；95%CI = 1.63 - 3.94）。这些差异主要出现在癌症诊断后的第一年。与圣保罗的非PWA相比，PWA的总生存率显著较低，这与高收入国家的情况相同。应强调加强PWA早期诊断并确保其接受适当癌症治疗的努力。
