Background: Burkitt lymphoma (BL) accounts for 10–35% of AIDS-defining lymphoma in people with HIV (PWH). Previous research consisting of smaller cohorts has shown decreased survival for HIV-associated BL. This study aims to compare overall mortality in BL patients with and without HIV, while investigating impact of treatment modalities in HIV-associated BL. Methods: Using the 2004–2019 NCDB, we identified 4312 patients with stage 3 or 4 BL who had a known HIV status and received either chemotherapy alone or chemotherapy and immunotherapy. Time to death was evaluated using Kaplan–Meier survival estimates. Risk of death was evaluated using an extended multivariable Cox model adjusted for multiple factors and with a Heaviside function for HIV status by time period (0–3 month vs. 3–60 month). Results: Of the 4312 patients included, 1514 (35%) had HIV. For months 0–3 from time of diagnosis, HIV status was not associated with a statistically significant increase in risk of death (HR = 1.04, 95% CI: 0.86, 1.26,p= 0.6648). From month 3to 60, positive HIV status was associated with a 55% increase in risk of death compared to those without HIV (95% CI: 1.38, 1.75,p< 0.0001). Further, this difference in hazard rates (0–3 vs. 3–60) was statistically significant (HR = 1.49, 95% CI: 1.22–1.82,p< 0.001). Conclusions: There is an increased mortality rate from months 3 to 60 in BL patients with HIV compared to patients without HIV. Additionally, risk of death in the first 3 months is significantly decreased by 45% in patients with HIV treated with combination chemotherapy and immunotherapy compared to patients without HIV receiving combination chemotherapy and immunotherapy, providing valuable clinical insight into treatment decision making in the care of HIV-associated BL.
背景：在HIV感染者中，伯基特淋巴瘤占艾滋病定义性淋巴瘤的10%-35%。既往基于较小规模队列的研究表明，HIV相关伯基特淋巴瘤患者的生存率较低。本研究旨在比较伴或不伴HIV感染的伯基特淋巴瘤患者的总体死亡率，并探讨不同治疗方案对HIV相关伯基特淋巴瘤的影响。 方法：通过分析2004-2019年美国国家癌症数据库资料，我们纳入了4312例已知HIV感染状态且接受单纯化疗或化疗联合免疫治疗的III-IV期伯基特淋巴瘤患者。采用Kaplan-Meier法评估生存时间，并运用考虑时间分段的Heaviside函数（0-3个月与3-60个月）建立多因素扩展Cox比例风险模型，分析HIV状态对死亡风险的影响。 结果：在4312例患者中，1514例（35%）为HIV感染者。诊断后0-3个月内，HIV感染状态未导致死亡风险显著增加（HR=1.04，95% CI：0.86-1.26，p=0.6648）。而在3-60个月期间，HIV阳性患者的死亡风险较HIV阴性患者增加55%（95% CI：1.38-1.75，p<0.0001）。进一步分析显示，两个时间段的风险比差异具有统计学意义（HR=1.49，95% CI：1.22-1.82，p<0.001）。 结论：与HIV阴性患者相比，HIV阳性伯基特淋巴瘤患者在诊断后3-60个月的死亡率显著升高。值得注意的是，在诊断后前3个月内，接受化疗联合免疫治疗的HIV感染者较接受相同治疗的HIV阴性患者的死亡风险降低45%，这一发现为HIV相关伯基特淋巴瘤的临床治疗决策提供了重要依据。
肿瘤(癌症)患者之家