All authors: Chelsea and Westminster Hospital, London, United Kingdom.
J Clin Oncol. 2014 Feb 10;32(5):409-14. doi: 10.1200/JCO.2013.51.6757. Epub 2013 Dec 30.
Combination antiretroviral therapy (cART) is standard of care for patients with HIV diagnosed with Kaposi's sarcoma (KS), but the current role of systemic chemotherapy is undefined.
Since 1998, a prospective stage-stratified approach has been adopted for 469 patients with HIV with KS. Patients with early-stage (T0) KS are treated with cART alone; patients with advanced-stage (T1) KS receive cART plus liposomal anthracycline chemotherapy. Clinical characteristics, overall survival, and KS progression-free survival were analyzed according to stage at presentation and treatment received.
A total of 303 patients presented with T0 stage KS, including 237 who were not receiving cART, and 166 patients had T1 stage KS. Patients with T0 KS had higher CD4 cell counts (P < .001); 90% of patients with T0 KS who were not receiving cART and 84% of those with T1 KS were treated in accordance with the stage-stratified approach. Median follow-up was 4.6 years, and 5-year overall survival was 89%; 54 patients have died, 15 as a result of KS. Overall 5-year survival was 92% for T0 KS and 83% to T1 KS (P = .0024). On-treatment analysis of 213 cART-naive patients with T0 KS treated with cART alone revealed 5-year overall survival of 95% and progression-free survival of 77%. For 140 patients with T1 disease treated with cART and liposomal anthracycline chemotherapy, 5-year overall survival was 85%.
This stage-stratified approach to the management of KS achieves high survival in patients with advanced KS and reduces exposure to chemotherapy in patients with early-stage KS.
联合抗逆转录病毒疗法（cART）是诊断为卡波西肉瘤（KS）的 HIV 患者的标准治疗方法，但目前全身化疗的作用尚未确定。
自 1998 年以来，我们对 469 例 HIV 合并 KS 患者采用了前瞻性的分层分期方法。早期（T0）KS 患者仅接受 cART 治疗；晚期（T1）KS 患者接受 cART 联合脂质体蒽环类化疗。根据分期和治疗方法分析患者的临床特征、总生存率和 KS 无进展生存率。
共 303 例患者为 T0 期 KS，其中 237 例未接受 cART，166 例为 T1 期 KS。T0KS 患者的 CD4 细胞计数较高（P<0.001）；90%未接受 cART 的 T0KS 患者和 84%的 T1KS 患者接受了分层分期治疗。中位随访时间为 4.6 年，5 年总生存率为 89%；54 例患者死亡，其中 15 例死于 KS。T0KS 的 5 年总生存率为 92%，T1KS 为 83%（P=0.0024）。对 213 例接受 cART 治疗的 T0KS 患者进行治疗分析，单纯 cART 治疗 5 年的总生存率为 95%，无进展生存率为 77%。对 140 例接受 cART 和脂质体蒽环类化疗的 T1 期患者，5 年总生存率为 85%。
这种分层分期方法治疗 KS 可使晚期 KS 患者的生存率提高，并减少早期 KS 患者接受化疗的机会。
