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Survival After Cancer in Italian Persons With AIDS, 1986–2005: A Population-Based Estimation

Maso, Luigino Dal PhD*; Suligoi, Barbara MD; Franceschi, Silvia MD; Braga, Claudia ScD*; Buzzoni, Carlotta ScD§,‖; Polesel, Jerry ScD*; Zucchetto, Antonella ScD*,¶; Piselli, Pierluca ScD#; Falcini, Fabio MD**; Caldarella, Adele MD; Zanetti, Roberto MD††; Vercelli, Marina MD‡‡; Guzzinati, Stefano ScD§§; Russo, Antonio PhD‖‖; Tagliabue, Giovanna MD¶¶; Iachetta, Francesco MD##; Ferretti, Stefano MD***; Limina, Rosa M. MD†††; Mangone, Lucia MD‡‡‡; Michiara, Maria MD§§§; Stracci, Fabrizio MD‖‖‖; Pirino, Daniela R. MD¶¶¶; Piffer, Silvano MD###; Giacomin, Adriano MD****; Vitarelli, Susanna MD††††; Mazzoleni, Guido MD‡‡‡‡; Iannelli, Arturo BSc§§§§; Contrino, Maria L. MD‖‖‖‖; Fusco, Mario MD¶¶¶¶; Tumino, Rosario MD####; Fanetti, Anna C. PhD*****; De Paoli, Paolo MD†††††; Decarli, Adriano PhD; Serraino, Diego MD*,‡‡‡‡‡and the Cancer and AIDS Registries Linkage Study

JAIDS Journal of Acquired Immune Deficiency Syndromes: August 1st, 2014 - Volume 66 - Issue 4 - p 428–435
doi: 10.1097/QAI.0000000000000184
Epidemiology and Prevention

Background: Cancer survival in persons with AIDS (PWA) after introduction of antiretroviral therapies remains poorly characterized. The aim is to provide population-based estimates of cancer survival, overall and for the most important cancer types in PWA, and a comparison with persons without AIDS (non-PWA) affected by the same cancer.

Methods: PWA with cancer at AIDS diagnosis or thereafter were individually matched with non-PWA by type of cancer, sex, age, year of diagnosis, area of living, and, for lymphomas, histological subtype. Five-year observed survival and hazard ratios (HRs) of death in PWA versus non-PWA with 95% confidence intervals (CIs) were estimated.

Results: We included 2262 Italian PWA and 4602 non-PWA with cancer diagnosed during 1986–2005. Between 1986 and 1995, and 1996 and 2005, 5-year survival for all cancers in PWA improved from 12% to 41% and the corresponding HR versus non-PWA decreased from 5.1 (95% CI: 4.3 to 6.1) to 2.9 (95% CI: 2.6 to 3.3). During 1996–2005, HRs were 2.0 (95% CI: 1.4 to 2.9) for Kaposi sarcoma, 3.4 (95% CI: 2.9 to 4.1) for non-Hodgkin lymphoma, and 2.4 (95% CI: 1.4 to 4.0) for cervical cancer. HRs were 2.5 (95% CI: 2.1 to 3.1) for all non–AIDS-defining cancers, 5.9 (95% CI: 3.1 to 11.2) for Hodgkin lymphoma, and 7.3 (95% CI: 2.8 to 19.2) for nonmelanoma skin cancer. A ≤3-fold survival difference was found for cancers of the stomach, liver, anus, lung, brain, and the most aggressive lymphoma subtypes.

Conclusions: The persisting, although narrowing, gap in cancer survival between PWA and non-PWA indicates the necessity of enhancing therapeutic approaches, so that PWA can be provided the same chances of survival observed in the general population, and improving cancer prevention and screening.

*Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, Italy;

Istituto Superiore di Sanità, Rome, Italy;

International Agency for Research on Cancer, Lyon, France;

§AIRTUM database, Florence, Italy;

Tuscany Cancer Registry, UO di epidemiologia clinica e descrittiva, Istituto per lo studio e la prevenzione oncologica, Florence, Italy;

Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy;

#Department of Epidemiology, INMI “L Spallanzani” IRCCS, Rome, Italy;

**Romagna Cancer Registry, Cancer Institute of Romagna IRCCS, Meldola, Italy;

††Piedmont Cancer Registry, Oncology Prevention Center (CPO), Torino, Italy;

‡‡Registro Tumori Regione Liguria, IRCSS Azienda Università Ospedale San Martino-IST Istituto nazionale ricerca sul cancro e Dipartimento di scienze della salute, Genoa University, Genoa, Italy;

§§Registro Tumori del Veneto, Istituto Oncologico Veneto IRCCS, Padua, Italy;

‖‖Milan Cancer Registry, Milan Health Authority, Epidemiology Unit, Milan, Italy;

¶¶Lombardia Cancer Registry, Varese Province, National Cancer Institute, Milan, Italy;

##Modena Cancer Registry, Department of Oncology, Hematology, and Respiratory Diseases, University of Modena and Reggio Emilia, Modena, Italy;

***Ferrara Cancer Registry, Ferrara University, Ferrara, Italy;

†††Brescia Health Unit, Cancer Registry, Brescia, Italy;

‡‡‡S.C. Statistica, qualità e studi clinici IRCCS, Arcispedale S. Maria Nuova, Reggio Emilia, Italy;

§§§Parma Province Cancer Registry, University Hospital Parma, Parma, Italy;

‖‖‖Umbria Cancer Registry, Department of Medical and Surgical Specialties, and Public Health, Section of Public Health, Perugia University, Perugia, Italy;

¶¶¶Cancer Registry of Sassari, Sassari, Italy;

###Registro Tumori della Provincia di Trento, Servizio di Epidemiologia Clinica e Valutativa, Trento, Italy;

****Registro Tumori Piemonte, Provincia di Biella CPO, Biella, Italy;

††††Macerata Province Cancer and Mortality Registry, Dipartimento Medicina Sperimentale e Sanità Pubblica, Camerino University, Camerino, Italy;

‡‡‡‡Alto Adige/Sudtirol Cancer Registry, Bolzano, Italy;

§§§§Salerno Cancer Registry, Salerno, Italy;

‖‖‖‖Siracusa Cancer Registry, ASP of Siracusa, Siracusa, Italy;

¶¶¶¶Campania Region Cancer Registry, ASL Napoli 3 Sud, Naples, Italy;

####Cancer Registry and Histopathology Unit, “Civic—M. P. Arezzo” Hospital, ASP Ragusa, Italy;

*****Sondrio Cancer Registry, Local Health Agency, Sondrio, Italy;

†††††Scientific Directorate, CRO Aviano National Cancer Institute, Italy; and

‡‡‡‡‡Friuli Venezia Giulia Cancer Registry, Central Health Direction, Udine, Italy.

Correspondence to: Luigino Dal Maso, PhD, Epidemiology and Biostatistics Unit, CRO Aviano National Cancer Institute, Via Franco Gallini 2, 33081 Aviano, Pordenone, Italy (e-mail: epidemiology@cro.it).

Cancer and AIDS Registries Linkage Study members are listed in the Appendix.

This work was supported by a grant from Emilia-Romagna Region.

The authors have no conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received December 13, 2013

Accepted April 02, 2014

© 2014 by Lippincott Williams & Wilkins