Background

The risk of anal cancer is increased among people with HIV, particularly men who have sex with men. Estimating survival by HIV status and sex and identifying groups at high risk is crucial for documenting prognostic differences between populations. We aimed to compare all-cause and anal cancer-specific survival in patients with anal cancer with and without HIV, stratified by sex, and to identify predictors of survival, stratified by HIV status.

Methods

In this retrospective cohort study, we used data from the HIV/AIDS Cancer Match Study of 13 population-based HIV and cancer registries throughout the USA. We included individuals aged 20–79 years diagnosed with invasive anal cancer between 2001 and 2019. To estimate associations between HIV status and both all-cause and anal cancer-specific mortality overall, we used Cox proportional hazards models, adjusting for year of and age at diagnosis, sex, race and ethnicity, histology, cancer stage, region, and treatment. We also calculated sex-specific adjusted hazard ratios (HRs). By HIV status, we identified characteristics associated with mortality. Models among people with HIV were further adjusted for AIDS status and HIV transmission risk group.

Findings

Between Jan 1, 2001, and Dec 31, 2019, 1161 (43·6%) of 2662 patients with anal cancer and HIV and 7722 (35·4%) of 21 824 patients without HIV died. HIV was associated with a 1·35 times (95% CI 1·24–1·47) increase in all-cause mortality among male patients and a 2·47 times (2·10–2·90) increase among female patients. Among patients with HIV, all-cause mortality was increased among non-Hispanic Black individuals (adjusted HR 1·19, 95% CI 1·04–1·38), people with AIDS (1·36, 1·10–1·68), people who inject drugs (PWID; 1·49, 1·17–1·90), patients with adenocarcinoma (2·74, 1·82–4·13), and those with no or unknown surgery treatment (1·34, 1·18–1·53). HIV was associated with anal cancer-specific mortality among female patients only (1·52, 1·18–1·97). Among patients with HIV, anal cancer-specific mortality was increased among patients with adenocarcinoma (3·29, 1·89–5·72), those with no or unknown treatment (1·59, 1·17–2·17), and PWID (1·60, 1·05–2·44).

Interpretation

HIV was associated with all-cause mortality among patients with anal cancer, especially women. Anal cancer-specific mortality was elevated among female patients with HIV. As screening for anal cancer becomes more widespread, examining the effects of screening on survival by HIV status and sex is crucial.

Funding

US National Cancer Institute Intramural Research Program.

中文翻译：

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2001 年至 2019 年间美国肛门癌患者的按性别和 HIV 状况划分的生存率：一项回顾性队列研究

背景

艾滋病毒感染者，尤其是男男性行为者，患肛门癌的风险增加。根据艾滋病毒状况和性别估计生存率并确定高危人群对于记录人群之间的预后差异至关重要。我们的目的是比较感染和不感染 HIV 的肛门癌患者的全因生存率和肛门癌特异性生存率（按性别分层），并确定按 HIV 状态分层的生存预测因子。

方法

在这项回顾性队列研究中，我们使用了美国 13 个基于人群的艾滋病毒和癌症登记处的艾滋病毒/艾滋病癌症匹配研究的数据。我们纳入了 2001 年至 2019 年间诊断出患有侵袭性肛门癌的 20-79 岁个体。为了估计 HIV 状况与全因死亡率和肛门癌特异性死亡率之间的总体关联，我们使用了 Cox 比例风险模型，并根据年份和年龄进行了调整包括诊断、性别、种族和民族、组织学、癌症分期、地区和治疗。我们还计算了特定性别的调整后风险比（HR）。根据艾滋病毒状况，我们确定了与死亡率相关的特征。艾滋病毒感染者模型根据艾滋病状况和艾滋病毒传播风险群体进行了进一步调整。

发现

2001年1月1日至2019年12月31日期间，2662名患有肛门癌和艾滋病毒的患者中有1161人（43·6%）死亡，而21824名没有艾滋病毒的患者中有7722人（35·4%）死亡。HIV与男性患者的全因死亡率增加1·35倍（95% CI 1·24–1·47）相关，而女性患者的全因死亡率增加2·47倍（2·10–2·90）。在艾滋病毒感染者中，非西班牙裔黑人（调整后的 HR 1·19，95% CI 1·04–1·38）、艾滋病患者（1·36、1·10–1·）的全因死亡率增加68）、注射吸毒者（注射吸毒者；1·49、1·17–1·90）、腺癌患者（2·74、1·82–4·13）以及未接受或未知手术治疗的患者（1 ·34, 1·18–1·53)。HIV仅与女性患者的肛门癌特异性死亡率相关（1·52、1·18–1·97）。在艾滋病毒感染者中，肛门癌特异性死亡率在腺癌患者（3·29、1·89–5·72）、未经治疗或治疗未知的患者（1·59、1·17–2·17）、和注射吸毒者 (1·60, 1·05–2·44)。

解释

艾滋病毒与肛门癌患者（尤其是女性）的全因死亡率相关。感染艾滋病毒的女性患者的肛门癌特异性死亡率升高。随着肛门癌筛查变得越来越普遍，检查艾滋病毒状况和性别筛查对生存的影响至关重要。

资金

美国国家癌症研究所校内研究计划。