Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins Hospital.
Institute of Human Virology, University of Maryland.
AIDS. 2018 Jan 14;32(2):171-177. doi: 10.1097/QAD.0000000000001664.
To evaluate gynecologic cancer treatments in HIV-infected women for adherence to National Comprehensive Cancer Network (NCCN) guidelines and to describe survival by adherence to guidelines.
Beyond cervical cancer, there are little data on treatment and outcomes for these women. This is a retrospective cohort study of HIV-infected women with gynecologic cancers.
HIV-infected women with gynecologic cancers from 2000 to 2015 were identified at two urban, comprehensive cancer centers. Chart reviews extracted demographic, HIV, and cancer-related variables. Cancer treatment was evaluated for adherence to NCCN guidelines. Overall survival was compared between those who received NCCN adherent and nonadherent cancer care.
Fifty-seven women were identified; 15 vulvar (26%), 26 cervical (46%), nine ovarian (16%), and seven endometrial (12%) cancers. Median time from HIV to cancer diagnosis was 8.5 years, and 88% of women were black. Thirty patients (53%) had stage I, and 27 (47%) had stage II-IV disease. Overall, 28 women (49%) received NCCN-adherent care; 22 of 30 stage I (73%) and six of 27 stage II-IV patients (22%). Among 29 women not receiving NCCN-adherent care, 69% were due to patient-related factors or toxicity. Among women with II-IV cancers, 48-month survival was higher in women who received NCCN-adherent care than those who did not (60 versus 28%).
Most HIV-infected women with advanced gynecologic cancers did not receive NCCN-adherent care and had worse survival compared to those who did. Focus on treatment-related toxicities and patient-related barriers to cancer care are necessary in this population.
评估感染艾滋病毒的女性的妇科癌症治疗是否符合国家综合癌症网络（NCCN）指南，并描述根据指南治疗的生存情况。
除宫颈癌外，针对这些女性的治疗和结局数据较少。这是一项对 2 家城市综合癌症中心的感染艾滋病毒的妇科癌症女性患者进行的回顾性队列研究。
从 2000 年至 2015 年，在两家城市综合癌症中心中确定了患有妇科癌症的感染艾滋病毒的女性。病历回顾中提取了人口统计学、艾滋病毒和癌症相关变量。评估癌症治疗是否符合 NCCN 指南。比较接受 NCCN 依从性癌症治疗和非依从性癌症治疗的患者的总生存率。
共确定了 57 名女性患者；15 名（26%）患有外阴癌，26 名（46%）患有宫颈癌，9 名（16%）患有卵巢癌，7 名（12%）患有子宫内膜癌。从艾滋病毒感染到癌症诊断的中位时间为 8.5 年，88%的患者为黑人。30 名患者（53%）患有 I 期疾病，27 名（47%）患有 II-IV 期疾病。总体而言，28 名（49%）患者接受了 NCCN 依从性治疗；30 名 I 期患者中有 22 名（73%）和 27 名 II-IV 期患者中有 6 名（22%）。在未接受 NCCN 依从性治疗的 29 名患者中，有 69%是由于患者相关因素或毒性。在患有 II-IV 期癌症的女性中，接受 NCCN 依从性治疗的女性比未接受 NCCN 依从性治疗的女性 48 个月生存率更高（60%对 28%）。
大多数患有晚期妇科癌症的感染艾滋病毒的女性未接受 NCCN 依从性治疗，且与接受治疗的患者相比，生存率较差。在该人群中，有必要关注与治疗相关的毒性和与患者相关的癌症治疗障碍。
