Incidence of first and second primary cancers diagnosed among people with HIV, 1985-2013: a population-based, registry linkage study
Incidence of first and second primary cancers diagnosed among people with HIV, 1985-2013: a population-based, registry linkage study
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DOI：
10.1016/s2352-3018(18)30179-6
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发表时间：
2018-11-01
期刊：
影响因子：
16.1
通讯作者：
Schwarcz, Sandra K.
中科院分区：
文献类型：
--
作者：
Hessol, Nancy A.;Whittemore, Hannah;Schwarcz, Sandra K.
癌症幸存者患后续原发性癌症的风险增加。艾滋病毒感染者罹患艾滋病定义型和非艾滋病定义型癌症的风险增加，但他们罹患第一和第二原发癌症的风险却知之甚少。我们确定了在旧金山被诊断为HIV的人群中发生的第一和第二原发癌症高于人群预期的数量，并比较了与抗逆转录病毒治疗的重要进展相对应的五个时间段的第一和第二原发癌症发病率。方法在这项基于人群的研究中，我们使用旧金山HIV/AIDS病例登记处来识别1990年1月1日至2010年12月31日期间在旧金山（CA， USA）被诊断为HIV/AIDS的16岁及以上人群。我们用计算机将登记处的记录与加州癌症登记处进行匹配，以确定1985年1月1日至2013年12月31日期间诊断出的原发性癌症。我们计算了1985年至2013年间，年份、年龄、性别和种族调整的标准化发病率，精确的95% ci和第一、第二艾滋病定义和非艾滋病定义癌症的发病率趋势。在1990年1月1日至2010年12月31日期间诊断为HIV的22 623人中，我们确定了5655例原发性癌症。我们排除了48例癌症序列无效的癌症和1062例原位肛门癌，留下4545例原发性癌症，包括4144例第一原发性癌症，372例第二原发性癌症，26例第三原发性癌症和3例第四或之后原发性癌症。卡波西肉瘤（127,95% CI 121-132）、非霍奇金淋巴瘤（17.2,16.1-18.4）、浸润性宫颈癌（8.0,4.1 -11.9）、肛门癌（46.7,39.7-53.6）、外阴癌（13.3,6.1-20.6）、霍奇金淋巴瘤（10.4,8.4-12.5）、眼窝癌（4.2,1.4-6.9）、唇癌（3.8,1.3-6.2）、阴茎癌（3.8,1.4-6）的标准化发病率均有所升高。1)，肝癌（3.0,2.3-3.7），其他癌症（2.3,1.7-3.0），睾丸癌（2.0,1.4-2.6），舌癌（1.9,1.1-2.7），肺癌（1.3,95% CI 1.1-1.6）。卡波西肉瘤（28.0,95% CI 20.2-35.9）、肛门癌（17.0,10.2-23.8）、非霍奇金淋巴瘤（11.1,9.3-12.8）、霍奇金淋巴瘤（5.4,1.1-9.7）和肝癌（3.6,1.4-5.8）的第二原发癌风险增加。我们观察到前列腺癌（0.6,95% CI 0.5 -0.7）、结肠癌（0.6,0.4-0.8）和胰腺癌（0.6,0.3-1.0）的第一原发癌标准化发病率较低，睾丸癌（0.3,0.0-0.9）、肾癌（0.4,0.0-0.9）和前列腺癌（0.6,0.2-0.9）的第二原发癌标准化发病率较低。第一和第二原发性艾滋病定义癌症发病率下降，第二原发性非艾滋病定义癌症发病率随时间增加。由于患第一和第二原发癌症的风险增加，因此需要在初次癌症诊断之前和之后加强对艾滋病毒感染者的癌症预防、筛查和治疗工作。爱思唯尔有限公司版权所有版权所有。
Background Cancer survivors are at increased risk for subsequent primary cancers. People living with HIV are at increased risk for AIDS-defining and non-AIDS-defining cancers, but little is known about their risk of first versus second primary cancers. We identified first and second primary cancers that occurred in above population expected numbers among people diagnosed with HIV in San Francisco, and compared first and second cancer incidence across five time periods that corresponded to important advances in antiretroviral therapy.Methods In this population-based study, we used the San Francisco HIV/AIDS case registry to identify people aged 16 years and older who were diagnosed with HIV/AIDS in San Francisco (CA, USA) between Jan 1, 1990, and Dec 31, 2010. We computer-matched records from the registry with the California Cancer Registry to identify primary cancers diagnosed between Jan 1, 1985, and Dec 31, 2013. We calculated year, age, sex, and race adjusted standardised incidence ratios with exact 95% CIs and trends in incidence of first and second AIDS-defining and non-AIDS-defining cancers from 1985 to 2013.Findings Of the 22 623 people diagnosed with HIV between Jan 1, 1990, and Dec 31, 2010, we identified 5655 incident primary cancers. We excluded 48 cancers with invalid cancer sequence numbers and 1062 in-situ anal cancers, leaving 4545 incident primary cancers, comprising 4144 first primary cancers, 372 second primary cancers, 26 third primary cancers, and three fourth or later primary cancers. First primary cancer standardised incidence ratios were elevated for Kaposi sarcoma (127, 95% CI 121-132), non-Hodgkin lymphoma (17.2, 16.1-18.4), invasive cervical cancer (8.0, 4 .1-11.9), anal cancer (46.7, 39.7-53.6), vulvar cancer (13.3, 6.1-20.6), Hodgkin's lymphoma (10.4, 8.4-12.5), eye and orbit cancer (4.2, 1.4-6.9), lip cancer (3.8, 1.3-6.2), penile cancer (3.8, 1.4-6. 1), liver cancer (3.0, 2.3-3.7), miscellaneous cancer (2.3, 1.7-3.0), testicular cancer (2.0, 1.4-2.6), tongue cancer (1.9, 1.1-2.7), and lung cancer (1.3, 95% CI 1.1-1.6). Second primary cancer risks were increased for Kaposi sarcoma (28.0, 95% CI 20.2-35.9), anal cancer (17.0, 10.2-23.8), non-Hodgkin lymphoma (11.1, 9.3-12.8), Hodgkin's lymphoma (5.4, 1.1-9.7), and liver cancer (3.6, 1.4-5.8). We observed lower first primary cancer standardised incidence ratios for prostate cancer (0.6, 95% CI 0 .5-0.7), colon cancer (0.6, 0.4-0.8), and pancreatic cancer (0.6, 0.3-1.0), and lower second primary cancer standardised incidence ratios for testicular cancer (0.3, 0.0-0.9), kidney cancer (0.4, 0.0-0.9), and prostate cancer (0.6, 0.2-0.9). First and second primary AIDS-defining cancer incidence declined, and second primary nonAIDS- defining cancer incidence increased over time.Interpretation Because of an increased risk for both first and second primary cancers, enhanced cancer prevention, screening, and treatment efforts are needed for people living with HIV both before and after initial cancer diagnosis. Copyright (C) 2018 Elsevier Ltd. All rights reserved.