Nasti Guglielmo, Martellotta Ferdinando, Berretta Massimiliano, Mena Maurizio, Fasan Marco, Di Perri Giovanni, Talamini Renato, Pagano Gabriella, Montroni Maria, Cinelli Roberta, Vaccher Emanuela, D'Arminio Monforte Antonella, Tirelli Umberto
Division of Medical Oncology A, Italian National Cancer Institute, Aviano, Italy.
Cancer. 2003 Dec 1;98(11):2440-6. doi: 10.1002/cncr.11816.
The objective of the current study was to evaluate the impact of highly active antiretroviral therapy (HAART) on clinical characteristics of presentation and the natural history of Kaposi sarcoma (KS) in patients already receiving HAART at the time of KS diagnosis.
The authors conducted a retrospective cohort study comparing epidemiologic, clinical, and outcome data for 160 patients who were naive to HAART at the time of KS diagnosis (KS-naive) with the corresponding data for 51 patients already receiving HAART at the time of KS diagnosis (KS-HAART). The analysis included all patients with a diagnosis of KS since January 1996 within two Italian cohorts of patients with human immunodeficiency virus.
Immunologic and virologic status at the time of KS diagnosis were significantly more favorable in the KS-HAART group than in the KS-naive group. The frequency of cutaneous involvement was similar in both groups, but cutaneous disease was more indolent among KS-HAART patients, with 1 anatomic site of involvement in 9 patients (21%) and less than 10 lesions in 26 patients (60%), compared with 16 patients (12%; P = 0.06) and 47 patients (34%; P = 0.01), respectively, in the KS-naive group. A smaller proportion of KS-HAART patients presented with visceral disease (24% vs. 39%; P = 0.06); in particular, gastrointestinal tract involvement was significantly less frequent among KS-HAART patients (14%) compared with KS-naive patients (28%; P = 0.05). Median survival was not reached in either group, and the 3-year survival rates of KS-HAART patients (64%) and KS-naive patients (78%) were not significantly different.
The data from the current study indicate that KS exhibits a less aggressive presentation in patients already receiving HAART compared with patients who are naive to HAART at KS diagnosis. Natural history and outcome do not appear to be influenced by the initiation of HAART before development of KS.
本研究的目的是评估高效抗逆转录病毒疗法（HAART）对在卡波西肉瘤（KS）诊断时已接受HAART治疗的患者的临床表现特征和KS自然病史的影响。
作者进行了一项回顾性队列研究，比较了160例在KS诊断时未接受过HAART治疗的患者（初治KS患者）与51例在KS诊断时已接受HAART治疗的患者（HAART治疗的KS患者）的流行病学、临床和结局数据。分析纳入了自1996年1月起在意大利两个人类免疫缺陷病毒患者队列中所有诊断为KS的患者。
KS诊断时，HAART治疗的KS患者组的免疫和病毒学状态明显优于初治KS患者组。两组皮肤受累频率相似，但HAART治疗的KS患者皮肤疾病进展较缓慢，9例患者（21%）有1个解剖部位受累，26例患者（60%）病变少于10个，而初治KS患者组分别为16例（12%；P = 0.06）和47例（34%；P = 0.01）。HAART治疗的KS患者出现内脏疾病的比例较小（24%对39%；P = 0.06）；特别是，与初治KS患者（28%；P = 0.05）相比，HAART治疗的KS患者胃肠道受累频率明显较低（14%）。两组均未达到中位生存期，HAART治疗的KS患者和初治KS患者的3年生存率（分别为64%和78%）无显著差异。
本研究数据表明，与KS诊断时未接受过HAART治疗的患者相比，已接受HAART治疗的患者中KS的表现侵袭性较小。KS的自然病史和结局似乎不受KS发生前开始HAART治疗的影响。
