title: Evaluation of the impact of HIV serostatus, tobacco smoking and CD4 counts on epidermoid anal cancer survival.
abstract: Tobacco smoking and HIV infection increase the risk of epidermoid anal cancer (EAC). No published studies have examined smoking and EAC outcomes, and the literature is discrepant regarding outcomes of HIV-positive patients with EAC. The goal of this study was to examine smoking history, HIV status and outcomes in EAC patients. We conducted a retrospective analysis of adults with invasive EAC treated in the University of Washington hospital system from 1 January 1994 to 31 December 2008. Sixty-three patients were included. Forty-seven patients (75%) had primary chemoradiation, of whom 42 (89%) completed therapy. Two patients (3%) received radiotherapy alone. Fourteen patients (22%) underwent primary surgery, of whom 11 (79%) underwent tumour excision and three (21%) abdominoperineal resection (APR). We analysed smoking history, HIV status and CD4 count (≥ 200 cells/μL/<200 cells/μL for HIV-positive patients) versus outcomes. Forty-five patients (71%) were in remission, and 44 (70%) were alive at last follow-up. Overall survival was significantly better for never-smokers than for ever-smokers. There were no differences in outcomes according to HIV status or CD4 counts. Patients with anal cancer who smoke have worse overall survival than non-smoking patients. HIV infection does not appear to affect anal cancer outcomes.
authors.affiliation: Department of Radiation Oncology, University of Washington Medical Center, University of Washington, Seattle, WA, USA. jlinam@uw.edu
authors.forename: J M
authors.initials: JM
authors.lastname: Linam
authors.forename: R R
authors.initials: RR
authors.lastname: Chand
authors.forename: V C
authors.initials: VC
authors.lastname: Broudy
authors.forename: K C
authors.initials: KC
authors.lastname: Liu
authors.forename: A L
authors.initials: AL
authors.lastname: Back
authors.forename: E H
authors.initials: EH
authors.lastname: Lin
authors.forename: S A
authors.initials: SA
authors.lastname: Patel
mesh_terms: D000328:Adult; D001005:Anus Neoplasms / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D018791:CD4 Lymphocyte Count; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology*; D015996:Survival Rate; D016896:Treatment Outcome; D014861:Washington / Q000453:epidemiology