非小细胞肺癌合并HIV感染/AIDS手术患者病理和临床特征及术后并发症影响因素分析

doi:10.19871/j.cnki.xfcrbzz.2024.02.006

摘要/Abstract

摘要： 目的分析非小细胞肺癌（non-small cell lung cancer,NSCLC）合并HIV感染/AIDS手术病理及临床特征和术后并发症的影响因素,为临床治疗决策提供依据。方法本研究回顾性分析2018年9月至2022年12月在成都市公共卫生临床医疗中心胸外科接受手术的NSCLC合并HIV感染/AIDS患者的病理及临床资料,探究病理及临床特征和术后并发症的危险因素。结果本研究共纳入50例患者,平均年龄（56.86±8.89）岁,其中男性占74.00%,女性占26.00%。腺癌占72.00%,鳞癌占28.00%。29例患者行基因检测及细胞程序性死亡配体1（programmed cell death ligand 1,PD-L1）蛋白检测,EGFR突变率62.06%、KRAS突变率17.24%、BRAF突变率6.90%、ALK突变率3.45%;PD-L1蛋白检测阳性率20.69%（6/29）。术后并发症发生率38.00%（19/50）,其中肺部感染14例、肺不张2例、脓气胸1例、乳糜胸2例。通过多因素Logistic回归分析提示术前抗病毒治疗时间≤4周、HIV载量≥40×10³copy/L、CD4⁺T淋巴细胞计数<200×10⁶/L为术后并发症的独立危险因素（P<0.05）。结论通过有效抗病毒治疗,保持较高的CD4⁺T淋巴细胞计数和较低的HIV载量,能有效减少NSCLC合并HIV感染/AIDS患者手术治疗的术后并发症。

关键词: 非小细胞肺癌, 人类免疫缺陷病毒, 术后并发症, 影响因素

Abstract: Objective To analyse the influencing factors of pathological and clinical characteristics and postoperative complications in patients with non-small cell lung cancer with HIV infection/AIDS. Method In this study, the pathological and clinical data of NSCLC patients with HIV infection/AIDS who underwent surgery in the Thoracic Surgery Department of Chengdu Public Health Clinical Medical Center from September 2018 to December 2022 and the pathological and clinical characteristics and risk factors of postoperative complications were analyzed. Result A total of 50 patients were included in this study, with a mean age of (56.86±8.89) years, of whom 74.00% were male and 26.00% were female. Adenocarcinoma accounted for 72.00%, and squamous carcinoma accounted for 28.00%. 29 patients underwent genetic testing and PD-L1 protein testing, and the mutation rate of EGFR was 62.06%, the mutation rate of KRAS was 17.24%, the mutation rate of BRAF was 6.90% and the mutation rate of ALK was 3.45%, and the positive rate of PD-L1 protein testing was 20.69% (6/29), and the rate of postoperative complications was 38.00% (19/50). including 14 cases of lung infection, 2 cases of pulmonary atelectasis, 1 case of pyothorax, and 2 cases of coeliac chest. The duration of preoperative antiretroviral therapy ≤4 weeks, HIV load ≥40×10³copy/L, and CD4⁺T lymphocyte count <200×10⁶/L were suggested to be independent risk factors for postoperative complications by multifactorial logistic regression analysis (P<0.05). Conclusion Maintaining a high CD4⁺T lymphocyte count and low HIV load through effective antiretroviral, it is effective in reducing postoperative complications of surgical treatment in patients with NSCLC combined with HIV infection/AIDS.

Key words: Non-small cell lung cancer, Human immunodeficiency virus, Postoperative complications, Factors

中图分类号:

R522
R654.7

王宁, 李刚, 龚胜, 宋毅杰, 李丹, 刘玉, 唐静, 陈朝琼, 蒋良双, 姚晓军. 非小细胞肺癌合并HIV感染/AIDS手术患者病理和临床特征及术后并发症影响因素分析[J]. 新发传染病电子杂志, 2024, 9(2): 29-33.

Wang Ning, Li Gang, Gong Sheng, Song Yijie, Li Dan, Liu Yu, Tang Jing, Chen Zhaoqiong, Jiang Liangshuang, Yao Xiaojun. Analysis of pathological and clinical characteristics and factors affecting postoperative complications in surgical patients with non-small cell lung cancer with HIV infection/AIDS[J]. Electronic Journal of Emerging Infectious Diseases, 2024, 9(2): 29-33.

参考文献

[1] WORLD HEALTH ORGANIZATION.Global HIV&AIDS statistics—FACT SHEET-WORLD AIDS DAY 2021[R]. Switzerland, world Health Organization, 2021: 1-6.
[2] SIGEL K, WISNIVESKY J, GORDON K, et al.HIV as an independent risk factor for incident lung cancer[J]. AIDS, 2012, 26(8): 1017-1025.
[3] 钟明, 宋毅杰, 王宁, 等. 719例HIV感染/AIDS合并恶性肿瘤的流行病学特征分析[J/CD]. 新发传染病电子杂志, 2022, 7(3): 60-63.
[4] 覃亚勤,罗凤,黎彦君,等. 艾滋病合并恶性肿瘤住院患者疾病谱分析[J/CD]. 新发传染病电子杂志,2022, 7(1):39-42.
[5] SMITH DM, SALTERS KA, EYAWO O, et al.Mortality among people living with HIV/AIDS with non-small-cell lung cancer in the modern HAART Era[J]. AIDS care, 2018, 30(7): 936-942.
[6] ZHENG R, ZHANG S, ZENG H, et al.Cancer incidence and mortality in China,2016[J]. J Natl Cancer Cent, 2022, 2(1): 1-9.
[7] SIGEL KM, STONE K, WISNIVESKY JP, et al.Short-term outcomes for lung cancer resection surgery in HIV infection[J]. AIDS, 2019, 33(8): 1353-1360.
[8] RAMI-PORTA R, ASAMURA H, TRAVIS WD, et al.Lung cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual[J]. CA Cancer J Clin, 2017, 67(2): 138-155.
[9] TRAVIS WD, BRAMBILLA E, NICHOLSON AG, et al.The 2015 World Health Organization Classification of Lung Tumors: Impact of Genetic,Clinical and Radiologic Advances Since the 2004 Classification[J]. J Thorac Oncol, 2015, 10(9): 1243-1260.
[10] HE C, WEI C, WEN J, et al.Comprehensive analysis of NGS and ARMS-PCR for detecting EGFR mutations based on 4467 cases of NSCLC patients[J]. J Cancer Res Clin Oncol, 2022, 148(2): 321-330.
[11] 林艳苹, 马露瑶, 马洁, 等. 非小细胞肺癌患者EGFR基因突变特征分析[J].中华肿瘤防治杂志, 2021, 28(15): 1119-1124.
[12] 魏丹凤, 郭元彪, 王战豪, 等. 四川地区非小细胞肺癌患者EGFR基因突变分型与临床病理特征的相关性分析[J]. 临床肿瘤学杂志, 2018, 23(10): 915-919.
[13] LIU Q, HUANG Q, YU Z, et al.Clinical characteristics of non-small cell lung cancer patients with EGFR mutations and ALK&ROS1 fusions[J]. Clin Respir J, 2022, 16(3): 216-225.
[14] 张晓敬, 赵丽华, 位嘉, 等. PD-L1在非小细胞肺癌中的表达与临床病理特征和基因突变的关系[J]. 标记免疫分析与临床, 2022, 29(12): 2058-2063.
[15] D'INCECCO A, ANDREOZZI M, LUDOVINI V, et al.PD-1 and PD-L1 expression in molecularly selected non-small-cell lung cancer patients[J]. Br J Cancer, 2015, 112(1): 95-102.
[16] THALER J, SIGEL C, BEASLEY MB, et al.Clinically significant mutations in HIV-infected patients with lung adenocarcinoma[J]. Br J Cancer, 2017, 117(9): 1392-1395.
[17] WANG L, WU L, LIU J, et al.Prognostic nomogram for surgery of lung cancer in HIV-infected patients[J]. J Thorac Dis, 2021, 13(1): 76-81.
[18] WANG L, CHEN Y, WANG Y, et al.Lung cancer surgery in HIV-infected patients:An analysis of postoperative complications and long-term survival[J]. Thorac Cancer, 2020, 11(8): 2146-2154.
[19] 潘珂君. 110例AIDS患者高效抗逆转录病毒治疗疗效观察[D], 乌鲁木齐:新疆医科大学, 2008.
[20] HORBERG MA, HURLEY LB, KLEIN DB, et al.Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy[J]. Arch Surg, 2006, 141(12): 1238-1245.
[21] GRABOWSKI G, PILATO A, CLARK C, et al.HIV in Orthopaedic Surgery[J]. J Am Acad Orthop Surg, 2017, 25(8): 569-576.
[22] 王琳,温子禄,陈辉,等.HIV感染合并非小细胞肺癌手术治疗患者的临床疗效和预后转归的观察[J]. 临床肺科杂志, 2018, 23(2): 195-199.
[23] TAKAHASHI S, OKUMA Y, WATANABE K, et al.Single-institutional experience of clinicopathological analysis and treatment for lung cancer patients with human immunodeficiency virus infection[J]. Mol Clin Oncol, 2017, 6(5): 765-769.
[24] SIGEL K, CROTHERS K, DUBROW R, et al.Prognosis in HIV-infected patients with non-small cell lung cancer[J]. Br J Cancer, 2013, 109(7): 1974-1980.