As antiretroviral therapy efficacy improves, HIV is gradually being recognized more as a chronic disease within the aging HIV-infected population. While these individuals are surviving into old age, they may, however, be experiencing “accelerated aging” with greater declines in physical function than that observed among comparably matched individuals free of HIV. This decline is not well understood and it remains unclear if physical decline correlates with the degree of immunosuppression based on CD4 lymphocyte nadir. In a cross-sectional study of accelerated aging in the older HIV-infected population on antiretroviral therapy (ART), physical performance evaluations were completed on a cohort of 107 HIV-infected subjects, age 50 years or older (with no HIV-1 RNA >200 copies/mL in the prior 12 months), and compared to reference ranges for age- and gender-matched HIV-uninfected persons. Physical performance testing consisted of four validated assessments: the 2.4-meter walk, 30-second chair stand, grip strength and 6-minute walk test. When compared to age- and gender-matched HIV-uninfected reference controls, older HIV-infected persons had diminished physical function. No correlation was found between physical function and degree of immunosuppression as determined by pre-ART CD4 nadir. Despite improved survival, HIV–infected adults on suppressive ART have diminished physical function compared to HIV-uninfected persons. The degree of HIV-associated immunosuppression does not correlate with the observed degree of physical function decline in older HIV-infected persons, suggesting the decline is mediated by other mechanisms.

Background: The current National Comprehensive Cancer Network advises neoadjuvant chemoradiotherapy followed by surgery for locally advanced cases of esophageal cancer. The role of immunotherapy in this context is under heavy investigation. Methods: Patients with esophageal adenocarcinoma were identified in the National Cancer Database (NCDB) from 2004 to 2019. Three groups were generated as follows: (a) no immunotherapy, (b) neoadjuvant immunotherapy, and (c) adjuvant immunotherapy. Overall survival was evaluated using the Kaplan–Meier method and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Results: Of the total 14,244 patients diagnosed with esophageal adenocarcinoma who received neoadjuvant chemoradiation, 14,065 patients did not receive immunotherapy, 110 received neoadjuvant immunotherapy, and 69 received adjuvant immunotherapy. When adjusting for established risk factors, adjuvant immunotherapy was associated with significantly improved survival compared to no immunotherapy and neoadjuvant immunotherapy during a median follow-up period of 35.2 months. No difference was noted among patients who received no immunotherapy vs. neoadjuvant immunotherapy in the same model. Conclusions: In this retrospective analysis of the NCDB, receiving adjuvant immunotherapy offered a significant survival advantage compared to no immunotherapy and neoadjuvant immunotherapy in the treatment of esophageal adenocarcinoma. The addition of neoadjuvant immunotherapy to patients treated with neoadjuvant chemoradiation did not improve survival in this cohort. Further studies are warranted to investigate the long-term outcomes of immunotherapy in esophageal cancer.

Introduction: Patients with metastatic melanoma to the lung typically have poor outcomes. Although a pulmonary metastasectomy for selected patients has been shown to improve survival, the role of surgical resection following the introduction of immunotherapy for metastatic melanoma is unknown. The objective of this study was to determine predictors of survival for patients with melanoma metastatic to the lung in the era of immunotherapy. Methods: In this retrospective study, data from the National Cancer Database were abstracted for patients with melanoma lung metastases. The overall survival was evaluated using Kaplan–Meier and Cox proportional hazard analysis, adjusting for previously described risk factors for mortality. Patients with concomitant metastases to organs other than the lung were excluded from the study. Results: A total of 625 patients with lung metastases at the time of a skin melanoma diagnosis were identified. A total of 280 patients underwent a pulmonary metastasectomy, 267 received immunotherapy, and 78 were treated with both a metastasectomy and immunotherapy. During a median follow-up time of 34.6 months [IQR: 14.2, 75.9], a metastasectomy was found to offer significantly improved survival compared to immunotherapy alone. No difference was noted between a metastasectomy and a combination of a metastasectomy and immunotherapy in the adjusted Cox proportional hazard model. Conclusions: When statistical models were adjusted for risk factors, a metastasectomy maintained a significant survival advantage compared to immunotherapy. The addition of immunotherapy to the treatment of patients treated with a pulmonary metastasectomy did not improve survival. Our findings support the role of surgery for patients with pulmonary metastatic melanoma.