Treatment and Outcomes of Oropharyngeal Cancer in People with Human Immunodeficiency Virus.
Treatment and Outcomes of Oropharyngeal Cancer in People with Human Immunodeficiency Virus.
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人类免疫缺陷病毒感染者口咽癌的治疗和结果。
DOI：
10.1089/aid.2019.0009
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发表时间：
2019
影响因子：
1.5
通讯作者：
Gross,Robert
中科院分区：
文献类型：
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作者：
Brickman,CristinaE;Propert,KathleenJ;Merlin,JessicaS;Liu,JeffreyC;Eady,Sequoya;Mcghee-Jez,Amy;Ragin,Camille;Grover,Surbhi;Cohen,RogerB;Gross,Robert
艾滋病毒阳性者患与人类乳头瘤病毒(HPV)感染相关的恶性肿瘤的风险增加，包括口咽鳞状细胞癌(OPSCC)。这项研究的目的是确定患有OPSCC的HIV阳性患者和HIV阴性患者之间是否存在癌症治疗差异。我们进行了一项回顾性队列研究，比较了抗逆转录病毒治疗后HIV阳性和HIV阴性患者的OPSCC治疗充分性和治疗结果。治疗充分性是通过测量与OPSCC存活率相关的两个主要终点来确定的：治疗时间和总辐射剂量。通过测量无病存活率和总存活率来评估治疗结果。我们总共确认了37名艾滋病毒阳性和149名艾滋病毒阴性的OPSCC患者。与HIV阴性者相比，HIV阳性者从确诊OPSCC到开始治疗的中位延迟时间为10天[危险比(HR)0.61，95%可信区间(CI)0.38-0.98]。艾滋病毒感染者的辐射后总剂量低于艾滋病毒阴性者[58.5Gray(Gyvs64.4Gyvs.64.4Gy.04，p= .04])。与HIV阴性者相比，HIV阳性者的疾病复发风险(HR 3.43，95%CI 1.39-8.46)和死亡风险(HR 4.21，95%CI 1.29-13.80)也更高。总而言之，我们发现，与HIV阴性患者相比，HIV阳性OPSCC患者的治疗时间延迟以及更差的无病和总体存活率，这在临床上具有重要意义。这些发现与了解艾滋病毒阳性者如何诊断和接受HPV相关恶性肿瘤的治疗有关，并突显了解决这一群体癌症治疗差异的必要性。
HIV-positive people are at increased risk for malignancies associated with human papillomavirus (HPV) infection, including oropharyngeal squamous cell carcinoma (OPSCC). The purpose of this study was to determine whether cancer treatment disparities exist between HIV-positive and HIV-negative people with OPSCC. We conducted a retrospective cohort study comparing OPSCC treatment adequacy and treatment outcomes in HIV-positive and HIV-negative people in the post-antiretroviral therapy era. Treatment adequacy was determined by measuring two primary endpoints associated with OPSCC survival: time to therapy and total radiation dose. Treatment outcomes were assessed by measuring disease-free and overall survival. We identified a total of 37 HIV-positive and 149 HIV-negative people with OPSCC. HIV-positive people experienced a median delay of 10 days from time of OPSCC diagnosis to start of therapy compared with HIV-negative people [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.38–0.98]. Total post-radiation dose in HIV-positive people was lower than that in HIV-negative people [58.5 Gray (Gy) versus 64.4 Gy,p= .04]. HIV-positive people also experienced greater hazards for disease recurrence (HR 3.43, 95% CI 1.39–8.46) and death (HR 4.21, 95% CI 1.29–13.80) compared with HIV-negative people. In conclusion, we detected a clinically important delay in time to therapy as well as worse disease-free and overall survival in HIV-positive people with OPSCC compared with their HIV-negative counterparts. These findings are relevant to understanding how HIV-positive people are diagnosed and undergo therapy for HPV-associated malignancies and highlight the need to address cancer treatment disparities in this group.