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Short-term outcomes for lung cancer resection surgery in HIV infection

Sigel, Keith M.a; Stone, Kimberlya; Wisnivesky, Juan P.a; Park, Lesley S.b; Kong, Chung Yinc; Silverberg, Michael J.d,e; Brown, Sheldona,f; Goetz, Matthewg,h; Rodriguez-Barradas, Maria C.i; Gibert, Cynthiaj; Shebl, Fatmak; Bedimo, Rogerl; Wadia, Roxannem; King, Joseph Jr.m,n; Crothers, Kristinao

doi: 10.1097/QAD.0000000000002200
EPIDEMIOLOGY AND SOCIAL
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Objective: Lung cancer is the leading cause of cancer death in people living with HIV (PWH). Surgical resection is a key component of potentially curative treatment regimens for early-stage lung cancers, but its safety is unclear in the setting of HIV. From a national cohort, we assessed potential differences in the risk of major lung cancer surgery complications by HIV status.

Design: We linked clinical and cancer data from the Veterans Aging Cohort Study (VACS) and Veterans Affairs Corporate Data Warehouse to outcomes from the Veterans Affairs Surgical Quality Improvement Program (VASQIP) and identified 8371 patients (137 PWH, 8234 uninfected) who underwent lung cancer surgeries between 2000 and 2016.

Methods: We compared rates of 15 major short-term surgical complications by HIV status.

Results: Use of surgical resection for early-stage lung cancer did not differ by HIV status. Lung cancer surgery postoperative (30-day) mortality was 2.0% for PWH and did not differ by HIV status (P = 0.9). Pneumonia was the most common complication for both PWH and uninfected veterans, but did not differ significantly in prevalence between groups (11.0% for PWH versus 9.4%; P = 0.5). The frequency of complications did not differ by HIV status for any complication (all P > 0.3). There were no significant predictors of postoperative complications for PWH.

Conclusions: In a national antiretroviral-era cohort of lung cancer patients undergoing surgical lung resection, short-term outcomes after surgery did not differ significantly by HIV status. Concerns regarding short-term surgical complications should have limited influence on treatment decisions for PWH with lung cancer.

aIcahn School of Medicine at Mount Sinai, New York, New York

bStanford University School of Medicine, Palo Alto, California

cInstitute for Technology Assessment, Massachusetts General Hospital, Boston, Massachusetts

dKaiser Permanente Northern California, Oakland, California

eUniversity of Washington School of Medicine, Seattle, Washington, District of Columbia

fJames J Peters VA Medical Center, Bronx, New York, New York

gVA Greater Los Angeles Healthcare System

hDavid Geffen School of Medicine at UCLA, Los Angeles, California

iMichael E. DeBakey VA Medical Center and Baylor University School of Medicine, Houston, Texas

jWashington DC VA Medical Center and George Washington University School of Medicine, Washington, District of Columbia

kMassachussets General Hospital, Boston, Massachusetts

lVA North Texas Healthcare Center and University of Texas Southwestern School of Medicine, Dallas, Texas

mVA Connecticut Healthcare System, West Haven

nYale University School of Medicine, New Haven, Connecticut

oUniversity of Washington School of Medicine, Seattle, Washington, District of Columbia, USA.

Correspondence to Keith M. Sigel, 17 East 102nd Street, 6th Floor, New York, NY 10029, USA. Tel: +1 646 283 8329; fax: +1 917 210 4057; e-mail: keith.sigel@mssm.edu

Received 7 January, 2019

Revised 2 February, 2019

Accepted 6 February, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.