Cancer stage at diagnosis in patients infected with the human immunodeficiency virus and transplant recipients.
BACKGROUND
It is unknown whether immunosuppression results in more aggressive, advanced stage cancers. Because cancer stage is influenced both by tumor biology and medical surveillance, the authors assessed cancer stage in individuals infected with the human immunodeficiency virus (HIV) and solid organ transplant recipients, 2 immunosuppressed groups with differences in their health care use.


METHODS
The authors used data on all cases of 15 cancer types diagnosed during 1996 through 2010 in 2 studies that linked US cancer registries with HIV and transplant registries. Odds ratios (ORs) for advanced (vs local) disease were estimated comparing HIV and transplant populations with immunocompetent individuals in polytomous logistic regression models adjusted for age, sex, race, registry, and year.


RESULTS
A total of 8411 of 4.5 million cancer cases occurred in HIV-infected individuals and 7322 of 6.4 million cancer cases occurred in transplant recipients. Compared with immunocompetent patients with cancer, those infected with HIV were more likely to be diagnosed with distant stage lung (OR, 1.13), female breast (OR, 1.99), and prostate (OR, 1.57) cancers, whereas transplant recipients had fewer distant stage lung (OR, 0.54), female breast (OR, 0.75), and prostate (OR, 0.72) cancers. Both immunosuppressed populations had a shift toward advanced stage melanoma (ORs of 1.97 for HIV-infected individuals and 1.82 for transplant recipients) and bladder cancer (ORs of 1.42 for HIV-infected individuals and 1.54 for transplant recipients).


CONCLUSIONS
Bladder cancer and melanoma were more likely to be diagnosed at a nonlocal stage in both HIV-infected individuals and transplant recipients, suggesting a role for immunosuppression in their progression. In addition, we observed a shift for some common cancers toward later stages in HIV-infected individuals and toward earlier stages in transplant recipients, which is consistent with differential access to medical care or surveillance.
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Meredith S
MS
Shiels
Michigan Cancer Surveillance Program, Michigan Department of Community Health, Lansing, Michigan.
Glenn
G
Copeland
Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Marc T
MT
Goodman
Utah Cancer Registry, Salt Lake City, Utah.
Janna
J
Harrell
Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, Iowa.
Charles F
CF
Lynch
New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, New Jersey.
Karen
K
Pawlish
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Ruth M
RM
Pfeiffer
Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland.
Eric A
EA
Engels
D000328:Adult; D000368:Aged; D005260:Female; D015658:HIV Infections / Q000276:immunology*; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects / Q000379:methods; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000276:immunology* / Q000473:pathology* / Q000821:virology; D066027:Transplant Recipients; D014181:Transplantation Immunology; D055815:Young Adult
cancer; human immunodeficiency virus (HIV); stage; transplant