Oncological features and prognosis of colorectal cancer in human immunodeficiency virus-positive patients: A retrospective study

doi:10.4240/wjgs.v16.i1.29

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World Journal of Gastrointestinal Surgery

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Retrospective Cohort Study

World J Gastrointest Surg. Jan 27, 2024; 16(1): 29-39
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.29

Table 1 Comparison of baseline data before and after propensity score matching

	Before PSM			After PSM
	HIV-negative (n = 363)	HIV-positive (n = 24)	P value	HIV-negative (n = 48)	HIV-positive (n = 24)	P value
Sex			1			1
Male	211 (58.1)	14 (58.3)		29 (60.4)	14 (58.3)
Female	152 (41.9)	10 (41.7)		19 (39.6)	10 (41.7)
Age (yr)	66.3 ± 10.6	63.6 ± 12.0	0.283	64.3 ± 12.4	63.6 ± 12.0	0.808
Tumor			0.466			0.833
Proximal colon	126 (34.7)	7 (29.2)		11 (22.9)	7 (29.2)
Distal colon	101 (27.8)	5 (20.8)		10 (20.8)	5 (20.8)
Rectum	136 (37.5)	12 (50.0)		27 (56.2)	12 (50.0)
Degree of differentiation			0.572			1
Low	36 (9.9)	3 (12.5)		6 (12.5)	3 (12.5)
Moderate	316 (87.1)	20 (83.3)		40 (83.3)	20 (83.3)
High	11 (3.0)	1 (4.2)		2 (4.2)	1 (4.2)
Tumor stage			0.425			1
T1	18 (5.0)	0 (0.0)		0 (0.0)	0 (0.0)
T2	53 (14.6)	6 (25.0)		13 (27.1)	6 (25.0)
T3	200 (55.1)	13 (54.2)		25 (52.1)	13 (54.2)
T4a	73 (20.1)	3 (12.5)		7 (14.6)	3 (12.5)
T4b	19 (5.2)	2 (8.3)		3 (6.2)	2 (8.3)

¹The tumor sites of colorectal cancer were classified as proximal colon (ICD-O3C180-84), distal colon (ICD-O3C185-87), and rectum (ICD-O3C199, C209) according to the International Classification of Diseases in Oncology.

Variables are expressed as median (P25, P75) or n (%). PSM: Propensity score matching; HIV: Human immunodeficiency virus; T: Tumor.

Table 2 Patient baseline data of the two groups

	HIV-positive (n = 24)	HIV-negative (n = 48)	P value
CRC family history	1 (4.2)	5 (10.4)	0.656
Main comorbidity	8 (33.3)	18 (37.5)	0.729
Hypertension	4 (16.7)	11 (22.9)	0.538
Diabetes mellitus	2 (8.3)	8 (16.7)	0.479
CHD	4 (16.7)	5 (10.4)	0.469
COPD	0	2 (4.2)	0.549
Drinking	6 (25)	16 (33.3)	0.469
Smoking	4 (16.7)	11 (22.9)	0.538
Abdominal surgery history	5 (20.8)	8 (16.7)	0.749
BMI (kg/m²)	22.06 (19.71, 23.95)	23.02 (21.03, 25.17)	0.074
Chemotherapy	7 (29.2)	30 (62.5)	0.008
Adverse reactions of chemotherapy	2 (28.6)	15 (50)	0.416
Fever¹	0	0	NA

¹Recurrent fever before or after surgery.

Variables are expressed as median (P25, P75) or n (%). HIV: Human immunodeficiency virus; CRC: Colorectal cancer; CHD: Coronary atherosclerotic heart disease; COPD, Chronic obstructive pulmonary disease; BMI: Body mass index; NA: Not available.

Table 3 Comparison of perioperative serologic indicators between human immunodeficiency virus-positive and -negative patients

	HIV-positive (n = 24)	HIV-negative (n = 48)	P value
Preoperative leukocytes (10⁹)	5.36 (3.85, 6.70)	5.92 (4.95, 7.50)	0.049
Postoperative leukocytes (10⁹)	6.91 (5.36, 8.84)	8.98 (6.97, 10.89	0.013
Preoperative hemoglobin (g/L)	123.50 (101.25, 139.75)	128.00 (120.00, 140.00)	0.229
Postoperative hemoglobin (g/L)	121.50 (96.00, 127.00)	119.00 (107.25, 125.25)	0.976
Preoperative lymphocytes (10⁹)	1.19 (0.77, 1.48)	1.48 (1.18, 1.90)	0.028
Postoperative lymphocyte	0.75 (0.49, 0.98)	0.79 (0.61, 1.07)	0.685
Preoperative albumin (g/L)	43.00 (37.00, 45.00)	41.00 (38.00, 44.00)	0.807
Postoperative albumin (g/L)	32.00 (28.00, 36.00)	29.00 (25.00, 34.75)	0.087
CEA (μg/L)	2.27 (1.38, 3.10)	5.44 (2.90, 20.00)	0.012
CA19-9 (U/mL)	13.96 (5.40, 20.85)	15.00 (6.99, 34.68)	0.983

Variables are expressed as median (P25, P75) or n (%). HIV: Human immunodeficiency virus; CEA: Carcinoembryonic Antigen; CA19-9: Carbohydrate antigen 199.

Table 4 Comparison of surgical outcomes between the two groups

	HIV-positive (n = 24)	HIV-negative (n = 48)	P value
Intraoperative blood loss (mL)	100 (50, 100)	50 (34, 100)	0.046
Operation time (min)	187.50 (151.25, 227.25)	195.00 (144.75, 240.00)	0.77
Time to first flatus (d)	3 (2, 4)	3 (2.25, 6)	0.668
Time to first defecation (d)	3 (1.25, 4.75)	3 (2, 6)	0.257
Time to first liquid intake (d)	2.5 (2, 3)	3 (2.25, 4)	0.064
Time to ambulation (d)	3 (3, 6.25)	3.5 (3, 4)	0.98
Postoperative hospital stay (d)	9 (7, 13.25)	8 (7, 11)	0.655
Postoperative complications	3 (12.5)	5 (10.4)	1.000
Admission to ICU	1 (4.2)	9 (18.8)	0.149
Time to stopping antibiotics (days)	2 (1, 2.75)	2 (1, 3.75)	0.679
Hospitalization expenses (thousand yuan)	78.7 (65.3, 88.6)	81.4 (67.5, 134.1)	0.173
PS at 1 mo after operation	1 (1, 1)	1 (1, 1)	0.48
Long-term postoperative gastrointestinal discomfort	8 (33.3)	12 (25)	0.457
Decrease in hemoglobin (g/L)	11 (0.5, 18.75)	12 (4, 22)	0.385
Decrease in albumin (g/L)	9.28 (4.75, 13.28)	12 (7, 15)	0.071
Intraoperative blood transfusion	1 (4.2)	1 (2.1)	1.000
Enterostomy	7 (29.2)	10 (20.8)	0.433
Readmission within 1 mo	0	0	NA
Death within 1 mo	0	0	NA
ASA score	3 (2, 3)	2 (2, 3)	0.713

Variables are expressed as median (P25, P75) or n (%). HIV: Human immunodeficiency virus; ICU: Intensive care unit; PS: Performance status; ASA: American Society of Anesthesiologists; NA: Not available.

Table 5 Oncological characteristics of patients in the two groups

	HIV-positive (n = 24)	HIV-negative (n = 48)	P value
Number of metastatic lymph nodes	1 (0, 3.5)	0 (0, 0)	0.001
Node stage	1 (0, 1.75)	0 (0, 1)	0.005
Harvested lymph nodes	13 (10, 15.75)	14.5 (11.25, 18)	0.223
Size of largest lymph node	0.85 (0.525, 1.45)	0.8 (0.5, 1)	0.318
Metastasis	2 (8.3)	2 (4.2)	0.597
TNM stage	3 (2, 3)	2 (2, 2.75)	0.004
Tumor size (cm)	3.75 (2.5, 5)	4 (3, 5)	0.497
Margin	0	0	NA
MSI	1 (11.1)	1 (6.3)	1
RAS gene mutation	3 (37.5)	13 (76.5)	0.087
BRAF gene mutation	0	1 (5.8)	1
MLH1	14 (82.4)	35 (92.1)	0.359
MSH2	16 (94.1)	37 (97.4)	0.527
MSH6	16 (94.1)	37 (97.4)	0.527
Ki-67 (%)	70 (60, 80)	60 (50, 80)	0.159

Variables are expressed as median (P25, P75) or n (%). HIV: Human immunodeficiency virus; MSI: Microsatellite instability; TNM: Tumor-Node-Metastasis; RAS: Rat sarcoma; BRAF: Serine/threonine protein kinase B-raf; MLH1: MutL homologue 1; MSH: Melanocyte-stimulating hormone; Ki-67: Antigen identified by monoclonal antibody Ki-67; NA: Not available.

Table 6 The number of metastatic lymph nodes, node stage, and tumor node metastasis stage in patients at different tumor stages

	T2 (n = 19)	T3 (n = 38)	T4a (n = 10)	T4b (n = 5)
Number of metastatic lymph nodes
HIV-positive	1 (0, 1.25)	1 (0, 3.5)	0 (0, -)	6 (4, -)
HIV-negative	0 (0, 0)	0 (0, 0)	0 (0, 3)	1 (0, -)
Node stage (0/I/II)
HIV-positive	2/4/0	5/5/3	2/0/1	0/0/2
HIV-negative	10/3/0/0	18/4/3	5/1/1	1/2/0
TNM stage (I/II/III/IV)
HIV-positive	2/0/4/0	0/5/8/0	0/2/1/0	0/0/0/2
HIV-negative	11/0/2/0	0/20/4/1	0/5/2/0	0/0/2/1

Variables are expressed as median (P25, P75) or n. HIV: Human immunodeficiency virus; T: Tumor; TNM: Tumor-Node-Metastasis.

Citation: Yang FY, He F, Chen DF, Tang CL, Woraikat S, Li Y, Qian K. Oncological features and prognosis of colorectal cancer in human immunodeficiency virus-positive patients: A retrospective study. World J Gastrointest Surg 2024; 16(1): 29-39
URL: https://www.wjgnet.com/1948-9366/full/v16/i1/29.htm
DOI: https://dx.doi.org/10.4240/wjgs.v16.i1.29