School of Medicine, University of Texas Southwestern, Dallas, Texas, USA.
Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Cancer. 2024 Jul 15;130(14):2462-2471. doi: 10.1002/cncr.35289. Epub 2024 Mar 26.
Cervical cancer associated with human papillomavirus has the highest cancer incidence and mortality for women in Botswana because of a high HIV prevalence and limited screening. This study investigates the significance of HIV on the overall survival (OS) of patients with locally advanced cervical cancer by various treatment categories (curative chemoradiation, definitive radiation [RT] alone, or palliative RT alone).
This study included patients diagnosed with cervical cancer between 2013 and 2020, prospectively enrolled in the Botswana Prospective Cancer Cohort. OS based on HIV status and completion of planned treatment regimen was estimated by the Kaplan-Meier method. Comparisons of 2-year OS by HIV status was performed by the log-rank test, univariate and multivariable Cox analyses adjusting for cancer stage, RT dose, number of chemotherapy cycles, and baseline hemoglobin levels.
Of 1131 patients diagnosed with stage IB-IVB cervical cancer, 69.8% were women living with HIV (n = 789). For patients receiving curative chemoradiation, HIV status was not significantly associated with OS in unadjusted (p = .987) and adjusted (p = .578) analyses. For RT only treatment and definitive (high-dose) RT alone, HIV status was significantly associated with OS in unadjusted analysis (HR = 1.77, p = .002; HR = 1.95, p = .014), but not in adjusted analysis (p = .227, p = .73). For patients receiving palliative (low-dose) RT, HIV status was not associated with OS in unadjusted (p = .835) or adjusted analysis (p = .359).
In Botswana, a resource-limited setting, HIV status had no significant effect on 2-year OS in patients with cervical cancer with well-managed HIV receiving chemoradiation, RT alone, or palliative RT. This demonstrates that patients living with HIV receiving antiretroviral treatment can receive clinically appropriate treatment with no evidence that HIV may lead to poorer outcomes.
由于博茨瓦纳艾滋病毒流行率高且筛查有限，人乳头瘤病毒导致的宫颈癌是该国女性中发病率和死亡率最高的癌症。本研究通过各种治疗类别（根治性放化疗、单纯根治性放疗或姑息性放疗），探讨了艾滋病毒对局部晚期宫颈癌患者总生存（OS）的影响。
本研究纳入了 2013 年至 2020 年间在博茨瓦纳前瞻性癌症队列中诊断为宫颈癌的患者。采用 Kaplan-Meier 法估计基于 HIV 状态和计划治疗方案完成情况的 OS。采用对数秩检验、单变量和多变量 Cox 分析比较 HIV 状态下的 2 年 OS，调整因素包括癌症分期、放疗剂量、化疗周期数和基线血红蛋白水平。
在 1131 名诊断为 IB-IVB 期宫颈癌的患者中，69.8%为 HIV 阳性女性（n=789）。对于接受根治性放化疗的患者，在未调整分析（p=0.987）和调整分析（p=0.578）中，HIV 状态与 OS 无显著相关性。对于仅接受放疗和根治性（高剂量）放疗的患者，在未调整分析中，HIV 状态与 OS 显著相关（HR=1.77，p=0.002；HR=1.95，p=0.014），但在调整分析中无相关性（p=0.227，p=0.73）。对于接受姑息性（低剂量）放疗的患者，在未调整（p=0.835）或调整分析（p=0.359）中，HIV 状态与 OS 均无相关性。
在资源有限的博茨瓦纳，管理良好的 HIV 合并宫颈癌患者接受放化疗、单纯放疗或姑息性放疗时，HIV 状态对 2 年 OS 无显著影响。这表明接受抗逆转录病毒治疗的 HIV 阳性患者可以接受临床适宜的治疗，没有证据表明 HIV 可能导致较差的结局。
