Association of cancer with AIDS-related immunosuppression in adults
Association of cancer with AIDS-related immunosuppression in adults
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DOI：
10.1001/jama.285.13.1736
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发表时间：
2001-04-04
影响因子：
120.7
通讯作者：
Goedert, JJ
中科院分区：
文献类型：
--
作者：
Frisch, M;Biggar, RJ;Goedert, JJ
需要大规模的研究来确定除了卡波西肉瘤、非霍奇金淋巴瘤和宫颈癌之外的癌症是否在人类免疫缺陷病毒（HIV）感染或获得性免疫缺陷综合征（AIDS）患者中过量发生。目的检查HIV/AIDS成人患者的一般癌症模式，并将免疫抑制相关癌症与HIV/AIDS患者中可能过量发生的其他癌症区分开来，设计、设置和受试者分析来自美国11个不同地理区域的以人群为基础的艾滋病和癌症登记数据，包括302834名15至69岁的HIV/AIDS成年人，研究期间在1978年至1996年期间因登记而异，主要结果测量癌症的相对风险（RR），通过将观察到的癌症病例数除以基于同期人群发病率的预期数量计算。我们根据3个标准定义了可能受免疫抑制影响的癌症：（1）AIDS前60个月至AIDS后27个月期间总体RR升高;（2）AIDS后4至27个月期间RR升高;（3）艾滋病发病前后RR呈上升趋势。结果艾滋病定义的恶性肿瘤的RR高于预期值，但非艾滋病定义的癌症也发生在统计学上显着超过（n =4422;总体RR，2.7; 95%置信区间[CI]，2.7 - 2.8），在个体癌症中，仅霍奇金病（n=612; RR，11.5; 95% CI，10.6- 12.5），尤其是混合细胞结构（n=217; RR，18.3; 95% CI，15.9-20.9）和淋巴细胞耗竭（n=36; RR，35.3; 95% CI，24.7-48.8）亚型;肺癌（n=808; RR，4.5; 95% CI，4.2-4.8）;阴茎癌（n=14; RR，3.9; 95% CI，2.1-6.5）;软组织恶性肿瘤（n=78; RR，3.3; 95% CI，2.6-4.1）;唇癌（n=20; RR，3.1; 95% CI，1.9-4.8）;和睾丸腺瘤（n=115; RR，2.0; 95%CI，1.7-2.4）符合与免疫抑制潜在相关的所有3个标准。结论尽管总体上过量，大多数非AIDS定义的癌症似乎不受与HIV疾病进展相关的免疫抑制进展的影响。一些符合我们与免疫抑制潜在相关性标准的癌症可能在HIV/AIDS患者中过度发生，因为这些人中大量吸烟（肺癌），频繁暴露于人乳头瘤病毒（阴茎癌）或卡波西肉瘤（软组织恶性肿瘤）的病例记录不准确。然而，霍奇金病，特别是混合细胞和淋巴细胞耗竭亚型，以及可能的唇癌和睾丸腺瘤可能真正受到免疫抑制的影响。
nContext Large-scale studies are needed to determine if cancers other than Kaposi sarcoma, non-Hodgkin lymphoma, and cervical cancer occur in excess in persons with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS),Objectives To examine the general cancer pattern among adults with HIV/AIDS and to distinguish immunosuppression-associated cancers from other cancers that may occur in excess among persons with HIV/AIDS,Design, Setting, and Subjects Analysis of linked population-based AIDS and cancer registry data from 11 geographically diverse areas in the United States, including 302834 adults aged 15 to 69 years with HIV/AIDS, The period of study varied by registry between 1978 and 1996,Main Outcome Measure Relative risks (RRs) of cancers, calculated by dividing the number of observed cancer cases by the number expected based on contemporaneous population-based incidence rates. We defined cancers potentially influenced by immunosuppression by 3 criteria: (1) elevated overall RR in the period from 60 months before to 27 months after AIDS; (2) elevated RR in the 4- to 27-month post-AIDS period; and (3) increasing trend in RR from before to after AIDS onset,Results Expected excesses were observed for the AIDS-defining cancers, but non-AIDS-defining cancers also occurred in statistically significant excess (n =4422; overall RR, 2.7; 95% confidence interval [CI], 2,7-2,8), Of individual cancers, only Hodgkin disease (n=612; RR, 11.5; 95% CI, 10.6-12,5), particularly of the mixed cellularity (n=217; RR, 18.3; 95% CI, 15.9-20.9) and lymphocytic depletion (n=36; RR, 35.3; 95% CI, 24.7-48.8) subtypes; lung cancer (n=808; RR, 4.5; 95% CI, 4.2-4.8); penile cancer (n=14; RR, 3.9; 95% CI, 2.1-6.5); soft tissue malignancies (n=78; RR, 3.3; 95% CI, 2.6-4.1); lip cancer (n=20; RR, 3,1; 95% CI, 1.9-4.8); and testicular seminoma (n=115; RR, 2.0; 95% CI, 1.7-2.4) met all 3 criteria for potential association with immunosuppression,Conclusion Although occurring in overall excess, most non-AIDS-defining cancers do not appear to be influenced by the advancing immunosuppression associated with HIV disease progression. Some cancers that met our criteria for potential association with immunosuppression may have occurred in excess in persons with HIV/AIDS because of heavy smoking (lung cancer), frequent exposure to human papillomavirus (penile cancer), or inaccurately recorded cases of Kaposi sarcoma (soft tissue malignancies) in these persons. However, Hodgkin disease, notably of the mixed cellularity and lymphocytic depletion subtypes, and possibly lip cancer and testicular seminoma may be genuinely influenced by immunosuppression.