Prognostic and Predictive Clinicopathologic Factors of Squamous Anal Canal Cancer in HIV-Positive and HIV-Negative Patients: Does HAART Influence Outcomes?

Emmanouil P. Pappou, Jonathan T. Magruder, Tao Fu, Caitlin Hicks, Joseph M. Herman, Sandy H Fang, Elizabeth C. Wick, Bashar Safar, Susan L Gearhart, Jonathan Efron

Research output: Contribution to journalArticle

Abstract

Background: The incidence of squamous cell carcinoma (SCC) of the anal canal has been rising over the past decades, especially in patients infected with human immunodeficiency virus (HIV). Despite the advent of potent multidrug regimens to treat HIV-termed highly active antiretroviral therapy (HAART), anal SCC rates have not declined, and the impact of HAART on anal SCC remains controversial. Aim: The purpose of this study was to define outcomes of anal SCC treatment in HIV-positive and HIV-negative patients. Methods and materials: A retrospective single-institution analysis was performed on all patients with anal SCC treated at the Johns Hopkins Hospital between 1991 and 2010. The primary outcomes measured were 5-year overall survival (5-year OS), median survival, and relapse rates. Results: Our search identified 93 patients with anal SCC. Patients had a mean age of 54 years; 37.6% were male, and 21.5% were HIV-positive. Median follow-up was 28 months. Relapse occurred in 16.1% of patients. Median time to relapse was 20 months. Relapse rates were slightly higher with HIV-positive versus negative patients (30.0 vs. 12.3%) but did not reach statistical significance (p = 0.06). Among HIV-positive patients, those who relapsed were more likely to be on HAART than those who did not relapse (83.3 vs. 14.3%, p = 0.007). 5-year OS was 58.9% for the total group of patients with no significant difference between those who relapsed versus those who did not (76.2 vs. 54.5%, p = 0.20). No survival difference was seen between HIV-positive and negative patients. Survival was associated with AJCC stage in all patients. Conclusion: In our small series, HIV infection was not associated with a significantly higher relapse rate or worse 5-year OS among patients with anal SCC. HAART was associated with a higher rate of relapse in HIV-positive patients. AJCC staging predicted survival in both relapsed and non-relapsed patients regardless of HIV status.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalWorld Journal of Surgery
DOIs
StateAccepted/In press - Sep 25 2017

Fingerprint

Anus Neoplasms
Highly Active Antiretroviral Therapy
Anal Canal
HIV
Squamous Cell Carcinoma
Recurrence
Survival
Virus Diseases

ASJC Scopus subject areas

  • Surgery

Cite this

@article{97a87222b379453b9168adb4b7a1401b,
title = "Prognostic and Predictive Clinicopathologic Factors of Squamous Anal Canal Cancer in HIV-Positive and HIV-Negative Patients: Does HAART Influence Outcomes?",
abstract = "Background: The incidence of squamous cell carcinoma (SCC) of the anal canal has been rising over the past decades, especially in patients infected with human immunodeficiency virus (HIV). Despite the advent of potent multidrug regimens to treat HIV-termed highly active antiretroviral therapy (HAART), anal SCC rates have not declined, and the impact of HAART on anal SCC remains controversial. Aim: The purpose of this study was to define outcomes of anal SCC treatment in HIV-positive and HIV-negative patients. Methods and materials: A retrospective single-institution analysis was performed on all patients with anal SCC treated at the Johns Hopkins Hospital between 1991 and 2010. The primary outcomes measured were 5-year overall survival (5-year OS), median survival, and relapse rates. Results: Our search identified 93 patients with anal SCC. Patients had a mean age of 54 years; 37.6{\%} were male, and 21.5{\%} were HIV-positive. Median follow-up was 28 months. Relapse occurred in 16.1{\%} of patients. Median time to relapse was 20 months. Relapse rates were slightly higher with HIV-positive versus negative patients (30.0 vs. 12.3{\%}) but did not reach statistical significance (p = 0.06). Among HIV-positive patients, those who relapsed were more likely to be on HAART than those who did not relapse (83.3 vs. 14.3{\%}, p = 0.007). 5-year OS was 58.9{\%} for the total group of patients with no significant difference between those who relapsed versus those who did not (76.2 vs. 54.5{\%}, p = 0.20). No survival difference was seen between HIV-positive and negative patients. Survival was associated with AJCC stage in all patients. Conclusion: In our small series, HIV infection was not associated with a significantly higher relapse rate or worse 5-year OS among patients with anal SCC. HAART was associated with a higher rate of relapse in HIV-positive patients. AJCC staging predicted survival in both relapsed and non-relapsed patients regardless of HIV status.",
author = "Pappou, {Emmanouil P.} and Magruder, {Jonathan T.} and Tao Fu and Caitlin Hicks and Herman, {Joseph M.} and Fang, {Sandy H} and Wick, {Elizabeth C.} and Bashar Safar and Gearhart, {Susan L} and Jonathan Efron",
year = "2017",
month = "9",
day = "25",
doi = "10.1007/s00268-017-4201-6",
language = "English (US)",
pages = "1--8",
journal = "World Journal of Surgery",
issn = "0364-2313",
publisher = "Springer New York",

}

TY - JOUR

T1 - Prognostic and Predictive Clinicopathologic Factors of Squamous Anal Canal Cancer in HIV-Positive and HIV-Negative Patients

T2 - Does HAART Influence Outcomes?

AU - Pappou, Emmanouil P.

AU - Magruder, Jonathan T.

AU - Fu, Tao

AU - Hicks, Caitlin

AU - Herman, Joseph M.

AU - Fang, Sandy H

AU - Wick, Elizabeth C.

AU - Safar, Bashar

AU - Gearhart, Susan L

AU - Efron, Jonathan

PY - 2017/9/25

Y1 - 2017/9/25

N2 - Background: The incidence of squamous cell carcinoma (SCC) of the anal canal has been rising over the past decades, especially in patients infected with human immunodeficiency virus (HIV). Despite the advent of potent multidrug regimens to treat HIV-termed highly active antiretroviral therapy (HAART), anal SCC rates have not declined, and the impact of HAART on anal SCC remains controversial. Aim: The purpose of this study was to define outcomes of anal SCC treatment in HIV-positive and HIV-negative patients. Methods and materials: A retrospective single-institution analysis was performed on all patients with anal SCC treated at the Johns Hopkins Hospital between 1991 and 2010. The primary outcomes measured were 5-year overall survival (5-year OS), median survival, and relapse rates. Results: Our search identified 93 patients with anal SCC. Patients had a mean age of 54 years; 37.6% were male, and 21.5% were HIV-positive. Median follow-up was 28 months. Relapse occurred in 16.1% of patients. Median time to relapse was 20 months. Relapse rates were slightly higher with HIV-positive versus negative patients (30.0 vs. 12.3%) but did not reach statistical significance (p = 0.06). Among HIV-positive patients, those who relapsed were more likely to be on HAART than those who did not relapse (83.3 vs. 14.3%, p = 0.007). 5-year OS was 58.9% for the total group of patients with no significant difference between those who relapsed versus those who did not (76.2 vs. 54.5%, p = 0.20). No survival difference was seen between HIV-positive and negative patients. Survival was associated with AJCC stage in all patients. Conclusion: In our small series, HIV infection was not associated with a significantly higher relapse rate or worse 5-year OS among patients with anal SCC. HAART was associated with a higher rate of relapse in HIV-positive patients. AJCC staging predicted survival in both relapsed and non-relapsed patients regardless of HIV status.

AB - Background: The incidence of squamous cell carcinoma (SCC) of the anal canal has been rising over the past decades, especially in patients infected with human immunodeficiency virus (HIV). Despite the advent of potent multidrug regimens to treat HIV-termed highly active antiretroviral therapy (HAART), anal SCC rates have not declined, and the impact of HAART on anal SCC remains controversial. Aim: The purpose of this study was to define outcomes of anal SCC treatment in HIV-positive and HIV-negative patients. Methods and materials: A retrospective single-institution analysis was performed on all patients with anal SCC treated at the Johns Hopkins Hospital between 1991 and 2010. The primary outcomes measured were 5-year overall survival (5-year OS), median survival, and relapse rates. Results: Our search identified 93 patients with anal SCC. Patients had a mean age of 54 years; 37.6% were male, and 21.5% were HIV-positive. Median follow-up was 28 months. Relapse occurred in 16.1% of patients. Median time to relapse was 20 months. Relapse rates were slightly higher with HIV-positive versus negative patients (30.0 vs. 12.3%) but did not reach statistical significance (p = 0.06). Among HIV-positive patients, those who relapsed were more likely to be on HAART than those who did not relapse (83.3 vs. 14.3%, p = 0.007). 5-year OS was 58.9% for the total group of patients with no significant difference between those who relapsed versus those who did not (76.2 vs. 54.5%, p = 0.20). No survival difference was seen between HIV-positive and negative patients. Survival was associated with AJCC stage in all patients. Conclusion: In our small series, HIV infection was not associated with a significantly higher relapse rate or worse 5-year OS among patients with anal SCC. HAART was associated with a higher rate of relapse in HIV-positive patients. AJCC staging predicted survival in both relapsed and non-relapsed patients regardless of HIV status.

UR - http://www.scopus.com/inward/record.url?scp=85029807836&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85029807836&partnerID=8YFLogxK

U2 - 10.1007/s00268-017-4201-6

DO - 10.1007/s00268-017-4201-6

M3 - Article

C2 - 28948325

AN - SCOPUS:85029807836

SP - 1

EP - 8

JO - World Journal of Surgery

JF - World Journal of Surgery

SN - 0364-2313

ER -