Incidence and survival of HNSCC patients living with HIV compared with HIV-negative HNSCC patients

Katharina Haase,Philipp Arens,Ullrich Keilholz,Max Heiland,Konrad Neumann,Benedicta Beck-Broichsitter,Nadine Thieme,Iris Piwonski,Grzegorz Kofla,Steffen Sander,Carmen Stromberger,Veit M Hofmann,Steffen Dommerich,Katharina Stölzel,Heidi Olze,Annekatrin Coordes

doi:10.1007/s00405-020-06573-9

Abstract

PurposeThe aim was to analyze the incidence and survival of patients living with HIV (PLWH) with head and neck squamous cell carcinoma (HNSCC) and to compare with a control group of HIV-negative HNSCC patients.MethodsClinicopathological data and predictors for overall survival (OS) and disease-free survival (DFS) were investigated (2009–2019).Results50 of 5151 HNSCC patients (0.97%) were PLWH, and 76% were smokers. Age ≤ 60 years, HIV-PCR ≤ 50 copies, CD4 cells ≤ 200/mm3, cART treatment, T and UICC classification, oral cavity and nasal/paranasal sinuses, and therapy were significantly associated with OS in univariate analysis. In the multivariate analysis, only age and HIV-PCR independently predicted OS. The OS of the 50 PLWH was not significantly altered compared with the 5101 HIV-negative controls. However, OS and DFS were significantly inferior in advanced tumor stages of PLWH compared with an age-matched control group of 150 HIV-negative patients.ConclusionsPLWH were diagnosed with HNSCC at a significantly younger age compared to HIV-negative patients. Taking into account patient age at initial diagnosis, both OS and DFS rates in PLWH are significantly worse compared with a matched control group of HIV-negative patients in advanced tumor stages UICC III/IV. The prognosis (OS) is improved when taking cART treatment, the HIV viral load is undetectable and CD4 count is high.

Highlights

The prevalence of HIV infections in Germany is 0.1% [1]
The mean age at the initial diagnosis of head and neck squamous cell carcinoma (HNSCC) in people live with HIV (PLWH) was 55 years (35–71), which was significantly less compared to the HIV-negative HNSCC patients (62 years (29–95), p < 0001). 92% of the HNSCC PLWH were male, 76% were smokers, and 40% were drinkers
As we found a significant difference in patient age at initial HNSCC diagnosis in PLWH compared with HIV-negative patients, we performed an additional matched-pair analysis (1:3 match) taking into account patient age, UICC stage, and tumor site (Table 4, Supplementary Fig. 2) which significantly impacted overall survival (OS) in PLWH

Summary

Introduction

The prevalence of HIV infections in Germany is 0.1% [1]. HIV infections impair lymphocyte function and are implicated in decreased tumor surveillance and increased cancer pathogenesis. Since the introduction of antiretroviral therapy in 1996, AIDS defining malignancies (ADMs) have declined, especially Kaposi sarcoma and non-Hodgkin lymphoma [2, 3]. HIV is a chronic infection and people live with HIV (PLWH). The decrease of ADMs has been associated with an increase in non-AIDS defining

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