Human Immunodeficiency Virus Infection as a Prognostic Factor in Surgical Patients With Non-Small Cell Lung Cancer
Human Immunodeficiency Virus Infection as a Prognostic Factor in Surgical Patients With Non-Small Cell Lung Cancer
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DOI：
10.1016/j.athoracsur.2011.11.012
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发表时间：
2012-02-01
影响因子：
4.6
通讯作者：
Brock, Malcolm V.
中科院分区：
文献类型：
--
作者：
Hooker, Craig M.;Meguid, Robert A.;Brock, Malcolm V.
背景本研究旨在评估人类免疫缺陷病毒（HIV）感染对非小细胞肺癌（NSCLC）患者术后生存的影响。一项回顾性队列研究比较了1985年至2009年在约翰霍普金斯医院接受切除术的22例HIV感染的肺癌患者和2,430例HIV状态不明的肺癌患者。采用个体匹配方法进行亚队列比较分析。30天死亡率在HIV感染者和HIV不明患者之间没有差异。HIV感染的肺癌患者的生存率明显短于HIV未指明的患者（中位数，26个月对48个月; p = 0.001）。调整后，HIV感染的NSCLC患者死亡率的相对风险是HIV未指明患者的3倍以上（调整后的风险比为3.08; 95%置信区间为1.85 ~ 5.13）。当在匹配的子队列中对其他手术特征进行建模时，相关性仍然具有统计学显著性（校正后的风险比为2.31; 95%置信区间为1.11至4.81）。此外，与CD 4计数为200个细胞/mm 3或更高的患者相比，CD 4计数低于200个细胞/mm 3的HIV感染肺癌患者的中位生存期缩短（8个月vs 40个月; p = 0.031）。术后肺部和感染并发症在HIV感染组中也有所增加（分别为p = 0.001和p < 0.001）。手术后，HIV感染患者的中位癌症进展时间（20.4个月）较HIV未指明患者短（p = 0.061）。HIV感染的NSCLC患者术后并发症多，病情进展快，术后生存率低。术前优化免疫状态和根据肺对一氧化碳的弥散能力仔细选择患者可能会改善患者的预后。(Ann Thorac Surg 2012;93：405-12）（C）2012，胸外科医师协会
Background. The purpose of this study was to assess the effect of human immunodeficiency virus (HIV) infection on postoperative survival among non-small cell lung cancer (NSCLC) patients.Methods. A retrospective cohort study compared 22 HIV-infected lung cancer patients to 2,430 lung cancer patients with HIV-unspecified status who underwent resection at Johns Hopkins Hospital from 1985 to 2009. Subcohort comparative analyses were performed using individual matching methods.Results. Thirty-day mortality rates did not differ between HIV-infected and HIV-unspecified patients. Survival rates for HIV-infected lung cancer patients were significantly shorter than for HIV-unspecified patients (median, 26 versus 48 months; p = 0.001). After adjustment, the relative hazard of mortality among HIV-infected NSCLC patients was more than threefold that of HIV-unspecified patients (adjusted hazard ratio, 3.08; 95% confidence interval: 1.85 to 5.13). When additional surgical characteristics were modeled in a matched sub-cohort, the association remained statistically significant (adjusted hazard ratio, 2.31; 95% confidence interval: 1.11 to 4.81). Moreover, HIV-infected lung cancer patients with CD4 counts less than 200 cells/mm(3) had shortened median survival compared with patients whose CD4 counts were 200 cells/mm(3) or greater (8 versus 40 months; p = 0.031). Postoperative pulmonary and infectious complications were also elevated in the HIV-infected group (p = 0.001 and p < 0.001, respectively). After surgery, median time to cancer progression was shorter among HIV-infected patients (20.4 months) versus HIV-unspecified patients (p = 0.061).Conclusions. The HIV-infected NSCLC patients have more postoperative complications, rapid progression to disease recurrence, and poorer postoperative survival. Optimizing immune status before surgery and careful patient selection based on diffusion capacity of lung for carbon monoxide may improve patient outcomes. (Ann Thorac Surg 2012;93:405-12) (C) 2012 by The Society of Thoracic Surgeons