Disparities in breast cancer survival between women with and without HIV across sub-Saharan Africa (ABC-DO): a prospective, cohort study.
Disparities in breast cancer survival between women with and without HIV across sub-Saharan Africa (ABC-DO): a prospective, cohort study.
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撒哈拉以南非洲妇女和患有HIV的妇女之间的乳腺癌生存差异（ABC-DO）：一项前瞻性，同类研究。
DOI：
10.1016/s2352-3018(21)00326-x
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发表时间：
2022-03
期刊：
影响因子：
16.1
通讯作者：
dos-Santos-Silva, Isabel
中科院分区：
文献类型：
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作者：
Chasimpha, Steady;McCormack, Valerie;Cubasch, Herbert;Joffe, Maureen;Zietsman, Annelle;Galukande, Moses;Parham, Groesbeck;Pinder, Leeya F.;Anele, Angelica;Adisa, Charles A.;Offiah, Awa Ukonye;Anderson, Benjamin O.;Boucheron, Pauline;Foerster, Milena;Schuz, Joachim;dos-Santos-Silva, Isabel
研究表明，与艾滋病毒阴性的乳腺癌妇女相比，感染艾滋病毒的乳腺癌妇女的死亡率更高。我们的目的是研究这种HIV差异如何因患者或乳腺肿瘤特征而变化。非洲乳腺癌-结局差异（ABC-DO）研究是一项前瞻性队列研究，在纳米比亚、尼日利亚、南非、乌干达和赞比亚的医院连续招募诊断时（2014- 2017年）发生乳腺癌的女性（年龄≥18岁）。在基线时收集详细的临床和流行病学数据，包括自我报告或检测的HIV状态。参与者每3个月通过电话进行积极随访。主要结果是全因死亡率，在基线访谈后至少有一个更新的生命状态的所有女性中进行评估。使用考克斯回归，我们检查了队列中HIV状态的总生存率的差异，以及国家和患者亚组之间的差异，调整了年龄，肿瘤分级和癌症诊断时的肿瘤分期。在2014年9月8日至2017年12月31日期间，我们招募了2154名患有原发性乳腺癌的女性，其中519人被排除在外，因为他们的国家有少数女性感染艾滋病毒进行比较。在其余的1 635名妇女中，313名（19%）感染艾滋病毒，1 184名（72%）艾滋病毒阴性，138名（9%）艾滋病毒状况不明。在乳腺癌诊断中，艾滋病毒感染者比艾滋病毒阴性者更年轻，体重指数（BMI）更低，但肿瘤分期、分级和受体亚型相似。在随访结束时（2019年1月1日），感染艾滋病毒的妇女（313人中的137人[44%]）死亡的比例高于艾滋病毒阴性妇女（1184人中的432人[37%]）。HIV感染女性的粗3年生存率（46% [95%CI 40-53]）比HIV阴性女性（55% [52-59];风险比（HR）1.41 [1.15 - 1.74]）低9%。HIV生存率差异不因年龄、BMI、肿瘤亚型或肿瘤分级而异，但在非转移性疾病女性中更强（3年生存率52% HIV阳性vs 63% HIV阴性女性，校正HR 1.65 [1.30 - 2.10]），而转移性癌症女性的生存率较低，无论HIV状态如何。患有非转移性乳腺癌的HIV感染女性中存在较大的生存缺陷，需要更好地了解这种差异的原因（例如，生物学机制，健康行为，有害的HIV-乳腺癌治疗相互作用或较高的HIV背景死亡率），以告知降低该患者群体死亡率的策略。Susan G科门，国际癌症研究机构，国家癌症研究所和英国英联邦奖学金。
Studies have shown increased mortality among women living with HIV diagnosed with breast cancer compared with HIV-negative women with breast cancer. We aimed to examine how this HIV differential varies by patient or breast tumour characteristics. The African Breast Cancer–Disparities in Outcomes (ABC-DO) study is a prospective cohort of women (aged ≥18 years) with incident breast cancer recruited consecutively at diagnosis (2014–17) from hospitals in Namibia, Nigeria, South Africa, Uganda, and Zambia. Detailed clinical and epidemiological data, including self-reported or tested HIV status, were collected at baseline. Participants were actively followed up via telephone calls every 3 months. The primary outcome was all-cause mortality, assessed in all women who had at least one updated vital status after baseline interview. Using Cox regression, we examined differences in overall survival by HIV status in the cohort, and across country and patient subgroups, adjusted for age, tumour grade, and tumour stage at cancer diagnosis. Between Sept 8, 2014, and Dec 31, 2017, we recruited 2154 women with primary breast cancer, 519 of whom were excluded due to their countries having small numbers of women with HIV for comparison. Among the remaining 1635 women, 313 (19%) were living with HIV, 1184 (72%) were HIV negative, and 138 (9%) had unknown HIV status. At breast cancer diagnosis, women with HIV were younger and had lower body-mass index (BMI) than their HIV-negative counterparts, but had similar tumour stage, grade, and receptor subtypes. At the end of the follow-up (Jan 1, 2019), a higher proportion of women with HIV (137 [44%] of 313) had died than had HIV-negative women (432 [37%] of 1184). Crude 3-year survival was 9% lower for women with HIV (46% [95% CI 40–53]) than for HIV-negative women (55% [52–59]; hazard ratio (HR) 1·41 [1·15–1·74]). The HIV survival differential did not differ by age, BMI, tumour subtype, or tumour grade, but was stronger in women with non-metastatic disease (3-year survival 52% HIV-positive vs 63% HIV-negative women, adjusted HR 1·65 [1·30–2·10]), whereas women with metastatic cancer had low survival, regardless of HIV status. The larger survival deficit among women with HIV with non-metastatic breast cancer calls for a better understanding of the reasons underlying this differential (eg, biological mechanisms, health behaviours, detrimental HIV–breast cancer treatment interactions, or higher HIV background mortality) to inform strategies for reducing mortality among this patient group. Susan G Komen, International Agency for Research on Cancer, National Cancer Institute, and UK-Commonwealth Scholarships.