de Almeida Robatto Amanda Acioli, Rocha Erika Andrade, Bonadio Renata Colombo, Galhera Denis Artico, Muratori Carolina Teixeira, Bueno Admir Andre Belo, Dornellas Abraão Ferreira Lopes, Alban Luciana Bastos Valente, Victor Carolina Ribeiro, Braghiroli Maria Ignez Freitas Melro, E Silva Marília Polo Mingueti, Araujo Camila Soares, Marques Carlos Frederico Sparapan, Nahas Caio Sergio Rizkallah, Ibrahim Karim Yaqub, Chen André Tsin Chih, Hoff Paulo Marcelo Gehm, Moniz Camila Motta Venchiarutti
ICESP - Instituto do Câncer do Estado de São Paulo, Dr. Arnaldo Avenue, Sao Paulo 01246-000, Brazil.
https://orcid.org/0000-0002-0255-0765.
Ecancermedicalscience. 2025 Jun 3;19:1922. doi: 10.3332/ecancer.2025.1922. eCollection 2025.
Pivotal studies with curative chemoradiation (CRT) in anal cancer did not include HIV-positive (HIV+) patients. HIV status impact remains unknown in this scenario.
In this retrospective matched cohort study, electronic medical records were reviewed at Sao Paulo State Cancer Institute between 2010 and 2021 patients with anal cancer T1-4 N0-1 M0 by AJCCVIII were selected. For each HIV+ patient, one or two HIV-negative (HIV-) cases were matched by age, stage (T, N) and ECOG. The primary endpoint was OS, estimated using Kaplan-Meir and compared with the log-rank test.
122 patients were selected, 45 being HIV+. The median follow-up was 37 months. Most patients, = 119 (98%), received concomitant CRT and had ECOG 0/1 ( = 116, 95%). Stage III corresponded to 69% of the patients ( = 85). Positive nodes were detected in 76 patients (62%). No difference was observed in complete clinical response (cCR) post-CRT (68% in HIV+ versus 63% in HIV-; = 0.6). Median recurrence-free survival (RFS) was not reached; 3-year RFS rates were 60.7% in HIV+ versus 63.1% in HIV- [hazard ratio (HR) 1.20, 95% CI 0.66-2.17, = 0.538]. Median OS was not reached; 3-year OS was 66.4% HIV+ versus 72.2% in HIV- (HR 1.23, 95% CI 0.61-2.47, = 0.546). HIV+ pts presented significantly more hospital admissions due to toxicity, 30% ( = 12/40) versus 13% ( = 10/74) ( = 0.049). No difference between groups was found for colostomy ( = 0.69) and salvage surgery ( = 1).
Anal carcinoma HIV+ patients treated with CRT presented similar cCR, RFS and OS compared with HIV- patients. Optimal therapy should be attempted in the HIV+ population; however, close clinical monitoring due to higher hospital admission is required.
肛门癌根治性放化疗（CRT）的关键研究未纳入HIV阳性（HIV+）患者。在这种情况下，HIV状态的影响尚不清楚。
在这项回顾性匹配队列研究中，对圣保罗州癌症研究所2010年至2021年期间的电子病历进行了回顾，选择了根据美国癌症联合委员会第八版分期为T1-4 N0-1 M0的肛门癌患者。对于每例HIV+患者，根据年龄、分期（T、N）和东部肿瘤协作组（ECOG）状态匹配一至两例HIV阴性（HIV-）患者。主要终点是总生存期（OS），采用Kaplan-Meir法估计，并通过对数秩检验进行比较。
共选择了122例患者，其中45例为HIV+。中位随访时间为37个月。大多数患者（n = 119，98%）接受了同步CRT，且ECOG评分为0/1（n = 116，95%）。III期患者占69%（n = 85）。76例患者（62%）检测到阳性淋巴结。CRT后完全临床缓解（cCR）率无差异（HIV+组为68%，HIV-组为63%；P = 0.6）。无复发生存期（RFS）未达到中位值；HIV+组3年RFS率为60.7%，HIV-组为63.1%[风险比（HR）1.20，95%置信区间（CI）0.66-2.17，P = 0.538]。OS未达到中位值；HIV+组3年OS率为66.4%，HIV-组为72.2%（HR 1.23，95%CI 0.61-2.47，P = 0.546）。HIV+患者因毒性反应导致的住院次数明显更多，分别为30%（n = 12/40）和13%（n = 10/74）（P = 0.049）。两组在结肠造口术（P = 0.69）和挽救性手术（P = 1）方面无差异。
接受CRT治疗的HIV+肛门癌患者与HIV-患者在cCR、RFS和OS方面相似。应尝试为HIV+人群提供最佳治疗；然而，由于住院次数较多，需要密切的临床监测。
