Okuku Fred, Krantz Elizabeth M, Kafeero James, Kamya Moses R, Orem Jackson, Casper Corey, Phipps Warren
*Uganda Cancer Institute, Kampala, Uganda; †Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda; ‡Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA; Departments of §Medicine; ‖Epidemiology; and ¶Global Health, University of Washington, Seattle, WA.
J Acquir Immune Defic Syndr. 2017 Apr 15;74(5):548-554. doi: 10.1097/QAI.0000000000001286.
HIV-associated Kaposi sarcoma (KS) is commonly staged using the AIDS Clinical Trials Group criteria, which classify 3 variables- tumor extent (T), immune status (I), and systemic symptoms (S)-into good risk (0) and poor risk (1). Although validated in the United States and Europe, these criteria have not been systematically evaluated in sub-Saharan Africa, where the burden of KS is greatest.
We reviewed medical charts of adult patients with HIV-associated KS seen at the Uganda Cancer Institute from 1992 to 2007. Vital status at 2 years after KS diagnosis was determined from the medical chart, or by contacting the patient or next of kin. Survival estimates used Kaplan-Meier methods. Predictors were evaluated for 2 periods: 0-4 months and 4-24 months after diagnosis.
At 2 years after diagnosis, 167 (41%) patients were alive, 156 (39%) had died, and 81 (20%) were lost to follow-up. The Kaplan-Meier estimate of 2-year survival was 57%. S1 was associated with death in months 0-4 [hazard ratio: 6.4, 95% confidence interval: 1.9-21.1], whereas T1 was associated with death in months 4-24 [hazard ratio: 4.0, 95% confidence interval: 1.4 to 11.5]. Immune status was not associated with survival.
Systemic symptoms were strongly associated with death in the early period after KS diagnosis, whereas tumor status was most predictive of death in the 4- to 24-month period. These findings suggest that different processes may influence outcomes in early and late periods following KS diagnosis. Further studies are needed to confirm these observations and to identify better predictors of KS survival in sub-Saharan Africa.
HIV相关的卡波西肉瘤（KS）通常采用艾滋病临床试验组标准进行分期，该标准将肿瘤范围（T）、免疫状态（I）和全身症状（S）这3个变量分为低风险（0）和高风险（1）。尽管这些标准在美国和欧洲得到了验证，但在撒哈拉以南非洲地区（KS负担最重的地区）尚未进行系统评估。
我们回顾了1992年至2007年在乌干达癌症研究所就诊的成年HIV相关KS患者的病历。通过病历、联系患者或其近亲确定KS诊断后2年的生命状态。生存估计采用Kaplan-Meier方法。在诊断后的0至4个月和4至24个月这两个时间段评估预测因素。
诊断后2年，167名（41%）患者存活，156名（39%）患者死亡，81名（20%）患者失访。2年生存率的Kaplan-Meier估计值为57%。S1与0至4个月内的死亡相关[风险比：6.4，95%置信区间：1.9至21.1]，而T1与4至24个月内的死亡相关[风险比：4.0，95%置信区间：1.4至11.5]。免疫状态与生存无关。
全身症状在KS诊断后的早期与死亡密切相关，而肿瘤状态在4至24个月期间对死亡的预测性最强。这些发现表明，不同的过程可能影响KS诊断后早期和晚期的预后。需要进一步研究来证实这些观察结果，并确定撒哈拉以南非洲地区KS生存的更好预测因素。
