Clinical presentation and outcome of colorectal cancer in HIV-positive patients: a clinical case-control study.
BACKGROUND
Data on colorectal cancer (CRC) in HIV-positive patients are limited. The study objective was to investigate and compare clinical presentation and outcome between HIV-positive and HIV-negative CRC patients.


METHODS
Between September 1985 and November 2003 we identified 27 cases of HIV-positive CRC patients from the cancer registry database - Italian Cooperative Group AIDS and Tumours (GICAT); the clinical presentation/outcome information was retrieved. Each HIV-positive patient from our institution was randomly matched (ratio 1:2) with HIV-negative patients (54 controls) based on age, sex, and year of diagnosis in the same time period. Differences in clinical presentation, treatment, and overall survival were assessed.


RESULTS
Of 1130 HIV-negative CRC patients, 54 were identified and matched with 27 HIV-positive patients. Compared with the HIV-negative patients, the HIV-positive patients had a higher risk of lower performance status (PS: > or =2) (odds ratio (OR) = 14.4; 95% confidence interval (CI): 3.6-57.7), a higher risk of unfavorable Dukes' stage (D) (OR = 4.9; 95% CI: 1.8-13.5), and a higher risk of poor grading (G3-G4) (OR = 5.0; 95% CI: 1.9-13.4). Median overall follow-up was 27 months (range: 2-212). At multivariate analysis, the only characteristics that significantly reduced the survival of the CRC patients were: HIV-positive status (hazard ratio (HR): 2.4; 95% CI: 1.1-5.2) and Dukes' stage D (HR: 3.7; 95% CI: 1.9-7.1).


CONCLUSIONS
Our data show that HIV-positive CRC patients compared to HIV-negative patients have a poorer PS, an unfavorable Dukes' stage, higher grading and shorter survival.
Berretta
Massimiliano
M
Division of Medical Oncology A, National Cancer Institute, Aviano, Italy. mberretta@cro.it
Cappellani
Alessandro
A
Di Benedetto
Fabrizio
F
Lleshi
Arben
A
Talamini
Renato
R
Canzonieri
Vincenzo
V
Zanet
Ernesto
E
Bearz
Alessandra
A
Nasti
Guglielmo
G
Lacchin
Teresa
T
Berretta
Salvatore
S
Fisichella
Rossella
R
Balestreri
Luca
L
Torresin
Augusta
A
Izzi
Immacolata
I
Ortolani
Patrizia
P
Tirelli
Umberto
U
D000328:Adult; D016022:Case-Control Studies; D015179:Colorectal Neoplasms / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate