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Systemic Inflammation-Based Biomarkers and Survival in HIV-Positive Subject With Solid Cancer in an Italian
Elena Raffetti1, Francesco Donato, Chiara Pezzoli
1*Unit of Hygiene, Epidemiology and Public Health, University of Brescia, Brescia, Italy; †University Division of Infectious and Tropical Diseases, University of Brescia, Brescia, Italy; ‡Institute of Clinical Infectious Diseases, Catholic University of Rome, Rome, Italy; §Division of Infectious Diseases, Department of Internal Medicine, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; ‖Division of Infectious Diseases, Santa Maria Annunziata Hospital, Bagnaripoli Florence, Italy; ¶Division of Infectious Diseases, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy; #Unit of Infectious Diseases, University Hospital of Ferrara, Ferrara, Italy; **Division of Infectious Diseases, Istituti Ospitalieri di Cremona, Cremona; ††Hospital Division of Infectious and Tropical Diseases, Spedali Civili Hospital, Brescia, Italy; and ‡‡Clinic of Infectious Diseases, University of Bari, Bari, Italy.
Background:
Recently, some systemic inflammation-based biomarkers have been demonstrated useful for predicting risk of death in patients with solid cancer independently of tumor characteristics. This study aimed to investigate the prognostic role of systemic inflammation-based biomarkers in HIV-infected patients with solid tumors and to propose a risk score for mortality in these subjects.
Methods:
Clinical and pathological data on solid AIDS-defining cancer (ADC) and non-AIDS-defining cancer (NADC), diagnosed between 1998 and 2012 in an Italian cohort, were analyzed. To evaluate the prognostic role of systemic inflammation- and nutrition-based markers, univariate and multivariable Cox regression models were applied. To compute the risk score equation, the patients were randomly assigned to a derivation and a validation sample.
Results:
A total of 573 patients (76.3% males) with a mean age of 46.2 years (SD = 10.3) were enrolled. 178 patients died during a median of 3.2 years of follow-up. For solid NADCs, elevated Glasgow Prognostic Score, modified Glasgow Prognostic Score, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, and Prognostic Nutritional Index were independently associated with risk of death; for solid ADCs, none of these markers was associated with risk of death. For solid NADCs, we computed a mortality risk score on the basis of age at cancer diagnosis, intravenous drug use, and Prognostic Nutritional Index. The areas under the receiver operating characteristic curve were 0.67 (95% confidence interval: 0.58 to 0.75) in the derivation sample and 0.66 (95% confidence interval: 0.54 to 0.79) in the validation sample.
Conclusions:
Inflammatory biomarkers were associated with risk of death in HIV-infected patients with solid NADCs but not with ADCs.
