Abstract
BackgroundThe incidence of anal cancer in human immunodeficiency virus (HIV)-positive individuals is increasing, and how co-infection affects outcomes is not fully understood. This study sought to describe the current outcome disparities between anal cancer patients with and without HIV undergoing abdominoperineal resection (APR).MethodsA retrospective review of all US patients diagnosed with anal squamous cell carcinoma, undergoing an APR, was performed. Cases were identified using a weighted derivative of the Healthcare Utilization Project’s National Inpatient Sample (2000–2011). Patients greater than 60 years old were excluded after finding a skewed population distribution between those with and without HIV infection. Multivariable logistic regression and generalized linear modeling analysis examined factors associated with postoperative outcomes and cost. Perioperative complications, in-hospital mortality, length of hospital stay, and hospital costs were compared for those undergoing APR with and without HIV infection.ResultsA total of 1725 patients diagnosed with anal squamous cell cancer undergoing APR were identified, of whom 308 (17.9 %) were HIV-positive. HIV-positive patients were younger than HIV-negative patients undergoing APR for anal cancer (median age 47 years old versus 51 years old, p < 0.001) and were more likely to be male (95.1 versus 30.6 %, p < 0.001). Postoperative hemorrhage was more frequent in the HIV-positive group (5.1 versus 1.5 %, p = 0.05). Mortality was low in both groups (0 % in HIV-positive versus 1.49 % in HIV-negative, p = 0.355), and length of stay (LOS) (10+ days; 75th percentile of patient data) was similar (36.9 % with HIV versus 29.8 % without HIV, p = 0.262).Greater hospitalization costs were associated with patients who experienced a complication. However, there was no difference in hospitalization costs seen between HIV-positive and HIV-negative patients (p = 0.66).ConclusionsHIV status is not associated with worse postoperative recovery after APR for anal cancer as measured by length of stay or hospitalization cost. Further study may support APRs to be used more aggressively in HIV-positive patients with anal cancer.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-016-0970-x) contains supplementary material, which is available to authorized users.
Highlights
The incidence of anal cancer in human immunodeficiency virus (HIV)-positive individuals is increasing, and how co-infection affects outcomes is not fully understood
Further analysis demonstrated that the age distribution of HIV-negative patients with anal cancer was bimodal, with a substantial portion greater than age 60 while the HIV-positive population was narrowly concentrated in a range less than 60 years old with no HIV-positive patients with anal cancer greater than 60 years old
HIV-positive patients were younger than HIV-negative patients undergoing abdominoperineal resection (APR) for anal cancer with a median age of 47 versus 51 years (p < 0.001), and HIV-positive patients were disproportionately male (95.1 versus 30.6 %, p < 0.001)
Summary
The incidence of anal cancer in human immunodeficiency virus (HIV)-positive individuals is increasing, and how co-infection affects outcomes is not fully understood. The incidence of squamous cell anal cancer in the last decade has been increasing [1], and the disease disproportionately affects HIV-positive individuals [2]. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology for anal carcinoma recommends chemoradiation therapy as the primary treatment [13]. This recommendation arises from historical findings that the majority of patients who underwent surgical resection had a complete pathological response with no evidence of residual tumor in the pathological specimen after neoadjuvant chemoradiation therapy was administered.
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