HIV Infection and Survival Among Women With Cervical Cancer
HIV Infection and Survival Among Women With Cervical Cancer
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DOI：
10.1200/jco.2016.67.9613
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发表时间：
2016-11-01
影响因子：
45.3
通讯作者：
Lockman, Shahin
中科院分区：
文献类型：
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作者：
Dryden-Peterson, Scott;Bvochora-Nsingo, Memory;Lockman, Shahin
目的宫颈癌是全球2000万HIV感染妇女中癌症死亡的主要原因。我们试图确定HIV感染是否影响妇女浸润性宫颈癌的生存率。患者和方法我们从2010年到2015年在博茨瓦纳招募了连续的宫颈癌患者。标准治疗包括外照射和近距离放射治疗，同时顺铂化疗。艾滋病毒对生存的影响估计通过使用逆概率加权边际考克斯model.ResultsA共348名妇女与宫颈癌，包括231（66.4%）与艾滋病毒和96（27.6%）没有艾滋病毒。大多数（189 [81.8%]）感染艾滋病毒的妇女在癌症诊断前接受了抗逆转录病毒治疗。感染艾滋病毒妇女的中位CD 4细胞计数为397（四分位数范围，264至555）。在中位随访19.7个月后，117名（50.7%）感染艾滋病毒的妇女和40名（41.7%）未感染艾滋病毒的妇女死亡。一人死于艾滋病毒，其余人死于癌症。感染艾滋病毒的妇女的三年生存率为35%（95% CI，27%至44%），未感染艾滋病毒的妇女的三年生存率为48%（95% CI，35%至60%）。在调整分析中，HIV感染显著增加了所有妇女的死亡风险（风险比，1.95; 95%CI，1.20至3.17），并在接受指南一致的治疗性治疗的子集（风险比，2.63; 95%CI，1.05至6.55）。HIV对生存期的不利影响在以下人群中更大：局限期癌症（P = 0.035）、治愈性治疗（P = 0.003）和CD 4细胞计数较低（P = 0.036）的女性。晚期和不良的治疗完成促成了高死亡率overall.ConclusionIn良好的访问和使用抗逆转录病毒治疗在博茨瓦纳的背景下，艾滋病毒感染显着降低宫颈癌的生存率。(C)2016年美国临床肿瘤学会
PurposeCervical cancer is the leading cause of cancer death among the 20 million women with HIV worldwide. We sought to determine whether HIV infection affected survival in women with invasive cervical cancer.Patients and MethodsWe enrolled sequential patients with cervical cancer in Botswana from 2010 to 2015. Standard treatment included external beam radiation and brachytherapy with concurrent cisplatin chemotherapy. The effect of HIV on survival was estimated by using an inverse probability weighted marginal Cox model.ResultsA total of 348 women with cervical cancer were enrolled, including 231 (66.4%) with HIV and 96 (27.6%) without HIV. The majority (189 [81.8%]) of women with HIV received antiretroviral therapy before cancer diagnosis. The median CD4 cell count for women with HIV was 397 (interquartile range, 264 to 555). After a median follow-up of 19.7 months, 117 (50.7%) women with HIV and 40 (41.7%) without HIV died. One death was attributed to HIV and the remaining to cancer. Three-year survival for the women with HIV was 35% (95% CI, 27% to 44%) and 48% (95% CI, 35% to 60%) for those without HIV. In an adjusted analysis, HIV infection significantly increased the risk for death among all women (hazard ratio, 1.95; 95% CI, 1.20 to 3.17) and in the subset that received guideline-concordant curative treatment (hazard ratio, 2.63; 95% CI, 1.05 to 6.55). The adverse effect of HIV on survival was greater for women with a more-limited stage cancer (P = .035), those treated with curative intent (P = .003), and those with a lower CD4 cell count (P = .036). Advanced stage and poor treatment completion contributed to high mortality overall.ConclusionIn the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival. (C) 2016 by American Society of Clinical Oncology