Cancer Stage at Diagnosis in HIV-infected People and Transplant Recipients

Details

• Alternative Title:
  Cancer
• Personal Author:
  Shiels, Meredith S. ; Copeland, Glenn ; Goodman, Marc T. ; Harrell, Janna ; Lynch, Charles F. ; Pawlish, Karen ; Pfeiffer, Ruth M. ; Engels, Eric A.
• Description:
  Background
  
  It is unknown whether immunosuppression results in more aggressive, advanced stage cancers. As cancer stage is influenced both by tumor biology and medical surveillance, we assessed cancer stage in HIV-infected individuals and solid organ transplant recipients, two immunosuppressed groups with differences in healthcare utilization.
  
  Methods
  
  We used data on all cases of 15 cancer types, diagnosed during 1996–2010 in two studies that linked U.S. cancer registries to HIV and transplant registries. Odds ratios (ORs) for advanced (vs. local) disease were estimated comparing HIV and transplant populations to immunocompetent people in polytomous logistic regression models, adjusted for age, sex, race, registry and year.
  
  Results
  
  A total of 8,411 of 4.5 million cancer cases occurred in HIV-infected people, and 7,322 of 6.4 million cancer cases occurred in transplant recipients. Compared to immunocompetent people with cancer, HIV-infected people were more likely to be diagnosed with distant stage lung (OR=1.13), female breast (OR=1.99), and prostate cancers (OR=1.57), while transplant recipients had fewer distant stage lung (OR=0.54), female breast (OR=0.75) and prostate cancers (OR=0.72). Both immunosuppressed populations had a shift toward advanced stage melanoma (ORs: HIV=1.97; transplant=1.82) and bladder cancer (ORs: HIV=1.42; transplant=1.54).
  
  Conclusions
  
  Bladder cancer and melanoma were more likely to be diagnosed at non-local stage in both HIV-infected people and transplant recipients, suggesting a role of immunosuppression in their progression. Additionally, we observed a shift for some common cancers toward later stages in HIV-infected individuals and toward earlier stages in transplant recipients, consistent with differential access to medical care or surveillance.
  
  
• Keywords:
  Adult Aged Cancer Female HIV HIV Infections Humans Immunosuppression Therapy Incidence Male Middle Aged Neoplasms Neoplasm Staging Stage Transplant Transplantation Immunology Transplant Recipients Young Adult

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• Source:
  Cancer. 121(12):2063-2071
• Pubmed ID:
  25739496
• Pubmed Central ID:
  PMC4470321
• Document Type:
  Journal Article
• Funding:
  U58 DP003931/DP/NCCDPHP CDC HHSUnited States/ ; U62 PS004011/PS/NCHHSTP CDC HHSUnited States/ ; 5458DP003920/DP/NCCDPHP CDC HHSUnited States/ ; 5U58/DP003931-02/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP003920/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP000807/DP/NCCDPHP CDC HHSUnited States/ ; 1U58 DP000807-01/DP/NCCDPHP CDC HHSUnited States/ ; 5U58DP003875-01/DP/NCCDPHP CDC HHSUnited States/ ; U62 PS001005/PS/NCHHSTP CDC HHSUnited States/ ; U62 PS004001/PS/NCHHSTP CDC HHSUnited States/ ; 5U58DP003883-03/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000037C/CA/NCI NIH HHSUnited States/ ; 5U58DP000824-04/DP/NCCDPHP CDC HHSUnited States/ ; N01-PC-35142/PC/NCI NIH HHSUnited States/ ; 5U62PS004015/PS/NCHHSTP CDC HHSUnited States/ ; N01PC35143/CA/NCI NIH HHSUnited States/ ; N01-PC-35137/PC/NCI NIH HHSUnited States/ ; U58 DP003883/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000035C/CA/NCI NIH HHSUnited States/ ; N01-PC-35139/PC/NCI NIH HHSUnited States/ ; 5U62PS004011-02/PS/NCHHSTP CDC HHSUnited States/ ; U58DP000832/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP003875/DP/NCCDPHP CDC HHSUnited States/ ; U58DP003879/DP/NCCDPHP CDC HHSUnited States/ ; U62PS004001-2/PS/NCHHSTP CDC HHSUnited States/ ; U58 DP000848-04/DP/NCCDPHP CDC HHSUnited States/ ; P30 CA086862/CA/NCI NIH HHSUnited States/ ; N01-PC-2013-00021/PC/NCI NIH HHSUnited States/ ; HHSN261201000036C/CA/NCI NIH HHSUnited States/ ; U58 DP003879/DP/NCCDPHP CDC HHSUnited States/ ; U58DP12-1205 3919-03/DP/NCCDPHP CDC HHSUnited States/ ; N01PC35137/CA/NCI NIH HHSUnited States/ ; 5U62PS001005-0/PS/NCHHSTP CDC HHSUnited States/ ; N01PC35142/CA/NCI NIH HHSUnited States/ ; Z99 CA999999/ImNIH/Intramural NIH HHSUnited States/ ; HHSN261201300021C/CA/NCI NIH HHSUnited States/ ; HHSN261201000035I/CA/NCI NIH HHSUnited States/ ; U58 DP000848/DP/NCCDPHP CDC HHSUnited States/ ; U62 PS004015/PS/NCHHSTP CDC HHSUnited States/ ; 5U58DP003921-03/DP/NCCDPHP CDC HHSUnited States/ ; HHSN261201000024C/CA/NCI NIH HHSUnited States/ ; HHSN261201000034C/CA/NCI NIH HHSUnited States/ ; U58 DP003921/DP/NCCDPHP CDC HHSUnited States/ ; U58 DP000832/DP/NCCDPHP CDC HHSUnited States/ ; N01PC35139/CA/NCI NIH HHSUnited States/ ; HHSN261201000026C/CA/NCI NIH HHSUnited States/ ; N01-PC-35143/PC/NCI NIH HHSUnited States/ ; U58 DP000824/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  121
• Issue:
  12
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:dd46c626a3eb4845462da5b3f01b5ac0c630e53d63ef2ed68b89f6f4e8d5e947
• Download URL:
  https://stacks.cdc.gov/view/cdc/32586/cdc_32586_DS1.pdf
• File Type:
  [PDF - 549.01 KB ]