Pre-treatment tumour PET metrics and clinical outcomes of anal cancer in patients living with and without HIV.

BACKGROUND/PURPOSE: To investigate if pre-treatment tumour positron-emission tomography (PET) metrics' prognostic efficacy changes with HIV or viral load (VL) in anal squamous cell carcinoma (ASCC).

MATERIALS AND

METHODS

Consecutive patients treated with definitive radiation therapy (RT) for non-metastatic ASCC from 2005 to 2021 at one institution were retrospectively identified. Patient demographic and clinical data, including HIV status and pre-treatment VL, were tabulated. Pre-treatment PET metrics were calculated with semi-automatic gradient-based segmentation algorithms. Cox-proportional-hazard and Kaplan-Meier modelling were used to investigate tumour PET metrics and outcomes: overall survival (OS), progression-free survival (PFS), and locoregional control (LRC).

RESULTS

A total of 175 patients were included: 110 HIV-negative and 65 patients living with HIV (PLWH). Nineteen PLWH had detectable pre-treatment VL. Median follow-up was 58 months (interquartile range [IQR]: 28-99), with 28 locoregional failures and 31 deaths. Five-year LRC, PFS, and OS was 84%, 73%, and 86%, respectively. There was no significant difference in LRC, PFS, or OS between HIV-negative patients and PLWH. 156 patients had available pre-treatment PET scans. Metabolic tumour volume and total lesion glycolysis were significantly associated with LRC and PFS on multivariate Cox analysis for the entire cohort (p ≤ 0.02), and HIV-negative patients on Cox sub-group analysis (p ≤ 0.01). No association between PET metrics and outcomes was seen for PLWH.

INTERPRETATION: Outcomes were comparable between HIV-negative patients and PLWH. Pre-treatment PET metrics were validated as significantly predicting outcomes for the entire cohort and HIV-negative patients, not PLWH. This may be from small numbers of PLWH patients, or non-specific uptake in patients with uncontrolled HIV reducing PET's prognostic efficacy.