title: Human immunodeficiency virus infection as a prognostic factor in surgical patients with non-small cell lung cancer.
abstract: BACKGROUND
  The purpose of this study was to assess the effect of human immunodeficiency virus (HIV) infection on postoperative survival among non-small cell lung cancer (NSCLC) patients.
  
  
  METHODS
  A retrospective cohort study compared 22 HIV-infected lung cancer patients to 2,430 lung cancer patients with HIV-unspecified status who underwent resection at Johns Hopkins Hospital from 1985 to 2009. Subcohort comparative analyses were performed using individual matching methods.
  
  
  RESULTS
  Thirty-day mortality rates did not differ between HIV-infected and HIV-unspecified patients. Survival rates for HIV-infected lung cancer patients were significantly shorter than for HIV-unspecified patients (median, 26 versus 48 months; p=0.001). After adjustment, the relative hazard of mortality among HIV-infected NSCLC patients was more than threefold that of HIV-unspecified patients (adjusted hazard ratio, 3.08; 95% confidence interval: 1.85 to 5.13). When additional surgical characteristics were modeled in a matched subcohort, the association remained statistically significant (adjusted hazard ratio, 2.31; 95% confidence interval: 1.11 to 4.81). Moreover, HIV-infected lung cancer patients with CD4 counts less than 200 cells/mm3 had shortened median survival compared with patients whose CD4 counts were 200 cells/mm3 or greater (8 versus 40 months; p=0.031). Postoperative pulmonary and infectious complications were also elevated in the HIV-infected group (p=0.001 and p<0.001, respectively). After surgery, median time to cancer progression was shorter among HIV-infected patients (20.4 months) versus HIV-unspecified patients (p=0.061).
  
  
  CONCLUSIONS
  The HIV-infected NSCLC patients have more postoperative complications, rapid progression to disease recurrence, and poorer postoperative survival. Optimizing immune status before surgery and careful patient selection based on diffusion capacity of lung for carbon monoxide may improve patient outcomes.
authors.affiliation: Department of Oncology, Johns Hopkins School of Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hooker
authors.forename: Robert A
authors.initials: RA
authors.lastname: Meguid
authors.forename: Alicia
authors.initials: A
authors.lastname: Hulbert
authors.forename: Joshua T
authors.initials: JT
authors.lastname: Taylor
authors.forename: James
authors.initials: J
authors.lastname: Shin
authors.forename: John
authors.initials: J
authors.lastname: Wrangle
authors.forename: Kristen
authors.initials: K
authors.lastname: Rodgers
authors.forename: Beverly
authors.initials: B
authors.lastname: Lee
authors.forename: Suvasini
authors.initials: S
authors.lastname: Laskshmanan
authors.forename: Travis
authors.initials: T
authors.lastname: Brown
authors.forename: Avedis
authors.initials: A
authors.lastname: Meneshian
authors.forename: Marc
authors.initials: M
authors.lastname: Sussman
authors.forename: Jeanne
authors.initials: J
authors.lastname: Keruly
authors.forename: Richard D
authors.initials: RD
authors.lastname: Moore
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
authors.forename: Malcolm V
authors.initials: MV
authors.lastname: Brock
mesh_terms: D000328:Adult; D000368:Aged; D002248:Carbon Monoxide / Q000493:pharmacokinetics; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000601:surgery; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D011653:Pulmonary Diffusing Capacity; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors
chemical_list: D002248:Carbon Monoxide