Burger H, Ismail Z, Taljaard J J
Division of Radiation Oncology, Department of Medical Imaging and Clinical Oncology, Tygerberg Academic Hospital and Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2018 Nov 26;108(12):1059-1065. doi: 10.7196/SAMJ.2018.v108i12.13202.
Kaposi's sarcoma (KS) typically occurs in the setting of immunodeficiency and specifically in the presence of HIV infection, when it is called AIDS-associated KS (AIDS-KS). In spite of impressive gains in the South African (SA) antiretroviral therapy (ART) roll-out programme since 2004, AIDS-KS still causes significant morbidity and mortality, and the treatment of advanced disease can be challenging owing to the centralisation of oncology services and the high incidence of concurrent infections. In 2014, a multidisciplinary AIDS-KS clinic (MKSC) was established at Tygerberg Hospital, Cape Town, with the goal of optimising management of AIDS-KS patients.
To report on the characteristics and outcomes of patients seen during the first 6 months after the inception of the MKSC.
A retrospective observational study was performed of all new cases referred to the MKSC from February to August 2014.
Forty-two patients were included in the study. The median age was 34 years (range 20 - 60). Forty-one patients were on ART at time of diagnosis or were initiated by a median of 3 months after diagnosis. The median CD4+ count before diagnosis was 147 cells/µL (range 4 - 811). The HIV viral load was undetectable in 22 cases (52.4%). Thirty-eight patients (90.5%) were classified as AIDS Clinical Trials Group (ACTG) poor risk, 10 patients (23.8%) had visceral KS, 14 patients (33.3%) were on tuberculosis (TB) treatment at time of presentation, and 22 patients (52.4%) received oncological therapy in addition to ART. After median follow-up of 25.6 months, 2-year overall survival (OS) was 61.1%. On univariate analysis, factors significantly associated with poor 2-year OS included ACTG S1 stage (S = systemic illness), visceral KS, being on TB treatment, and Eastern Cooperative Oncology Group performance status score >2. In the T1 (T = tumour extent) subgroup, receiving chemotherapy was significantly associated with improved 2-year OS.
Advanced AIDS-KS significantly affects young people in the Western Cape Province of SA despite 10 years of ART roll-out. There is a high prevalence of concomitant TB infection that could adversely affect adherence and response to treatment. Despite advanced disease at presentation and palliative treatment intent, survival outcomes are encouraging and seem to be positively affected by the increased use of chemotherapy. A multidisciplinary approach to diagnosis, staging and treatment and the exploration of prognostic indices specific to the sub-Saharan setting would be valuable in designing appropriate treatment algorithms.
卡波西肉瘤（KS）通常发生于免疫缺陷的情况下，特别是在存在人类免疫缺陷病毒（HIV）感染时，此时被称为艾滋病相关卡波西肉瘤（AIDS-KS）。尽管自2004年以来南非（SA）抗逆转录病毒疗法（ART）推广项目取得了显著成效，但AIDS-KS仍然导致严重的发病率和死亡率，由于肿瘤服务的集中化以及并发感染的高发生率，晚期疾病的治疗可能具有挑战性。2014年，在开普敦泰格堡医院设立了一个多学科AIDS-KS诊所（MKSC），目标是优化AIDS-KS患者的管理。
报告MKSC成立后头6个月内就诊患者的特征和结局。
对2014年2月至8月转诊至MKSC的所有新病例进行回顾性观察研究。
42例患者纳入研究。中位年龄为34岁（范围20 - 60岁）。41例患者在诊断时正在接受ART治疗，或在诊断后中位3个月开始接受治疗。诊断前CD4 +细胞计数的中位数为147个/μL（范围4 - 811）。22例（52.4%）患者的HIV病毒载量检测不到。38例（90.5%）患者被归类为艾滋病临床试验组（ACTG）低风险，10例（23.8%）患者有内脏KS，14例（33.3%）患者在就诊时正在接受结核病（TB）治疗，22例（52.4%）患者除接受ART治疗外还接受了肿瘤治疗。中位随访25.6个月后，2年总生存率（OS）为61.1%。单因素分析显示，与2年OS不良显著相关的因素包括ACTG S1期（S =全身疾病）、内脏KS、正在接受TB治疗以及东部肿瘤协作组体能状态评分>2。在T1（T =肿瘤范围）亚组中，接受化疗与2年OS改善显著相关。
尽管ART推广已达10年，但晚期AIDS-KS仍对南非西开普省的年轻人产生重大影响。合并TB感染的患病率很高，这可能对治疗依从性和反应产生不利影响。尽管就诊时疾病已属晚期且治疗目的为姑息性，但生存结局令人鼓舞，化疗使用增加似乎对其有积极影响。多学科的诊断、分期和治疗方法以及探索撒哈拉以南地区特有的预后指标，对于设计合适的治疗方案将具有重要价值。
