背景:肛门癌在全球范围内正在增加,在高度发达国家出现了大量新病例,包括美国在内,肛门癌的发病率在艾滋病毒感染者(PLHIV)中更高,美国南部继续看到更高的艾滋病毒发病率和滞后的HPV疫苗接种率。我们旨在确定与阿拉巴马州早发性肛门癌相关的因素,这可能有助于解释南方的癌症差异。
方法:使用横断面研究设计,我们检查了人口统计,临床,2012年至2018年阿拉巴马州癌症登记处按诊断年龄(<50岁和≥50岁)分层的肛门癌患者的社会特征。我们使用Wilcoxon秩和和Pearson卡方检验来评估诊断时年龄之间的关联,人口统计(即,性别,种族,婚姻状况),临床(即,BMI,HIV感染,site,舞台,和组织学类型),和社会(即社会脆弱性)特征,和多变量逻辑回归来估计早发性癌症的几率。
结果:在阿拉巴马州的519例肛门癌患者中,92(17.7%)在<50岁时被诊断。大多数患者为女性(66.5%)和白人(83.4%)。男性,黑人种族,HIV感染与诊断时年龄较小有关.与白人患者相比,黑人患者早发性肛门癌的几率增加了4倍(AOR=4.39,CI=1.54-12.49)。黑人患者不成比例地生活在社会脆弱性较高的地区。在社会脆弱性最高的地区,约有42%的患者被诊断出患有3或4期癌症。大约8%的病例发生在35-44岁的人群中,这接近美国这个年龄段的肛门癌病例比例的两倍(4.7%)。
结论:黑人患者,男性,与南方其他人群相比,PLHIV可能有更高的早发性肛门癌风险。
BACKGROUND: Anal cancer is increasing globally, with a high number of new cases occurring in highly developed countries, including the U.S. The incidence of anal cancer is higher among people living with HIV (PLHIV), and the U.S. South continues to see higher HIV incidence rates and lagging HPV vaccination rates. We aimed to identify factors associated with early onset anal cancer in Alabama which may help explain cancer disparities in the South.
METHODS: Using a cross-sectional study design, we examined demographic, clinical, and social characteristics among anal cancer patients stratified by diagnosis age (<50 and ≥50 years) in the Alabama cancer registry between 2012 and 2018. We used Wilcoxon rank sums and Pearson chi-square tests to assess associations between age at diagnosis, demographic (i.e., sex, race, marital status), clinical (i.e., BMI, HIV infection, site, stage, and histological type), and social (i.e. social vulnerability) characteristics, and multivariable logistic regression to estimate the odds of early onset cancer.
RESULTS: Among 519 patients with anal cancer in Alabama, 92 (17.7 %) were diagnosed at <50 years. The majority of patients were female (66.5 %) and White (83.4 %). Male sex, Black race, and HIV infection were associated with younger age at diagnosis. Black patients had a 4-fold increased odds of early onset anal cancer compared to White patients (AOR=4.39, CI=1.54-12.49). Black patients disproportionately lived in areas with higher social vulnerability. About 42 % of patients in areas with the highest social vulnerability were diagnosed with stage 3 or 4 cancer. About 8 % of cases were among people aged 35-44 years, which is close to double the proportion of anal cancer cases in this age group in the U.S. (4.7 %).
CONCLUSIONS: Patients who are Black, male, and PLHIV may be at higher risk of early onset anal cancer compared to other populations in the South.