Wang Haili, Guo Chengnan, Zhang Xin, Xu Yiyun, Li Yi, Wang Tianye, Liu Zhenqiu, Zhu Xiaohua, Zhang Tiejun
Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China.
Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
HIV Med. 2024 Jan;25(1):60-71. doi: 10.1111/hiv.13530. Epub 2023 Aug 13.
Despite the improved survival of patients with AIDS and Kaposi's sarcoma (KS), competing events are a non-negligible issue affecting the survival of such patients. In this study, we explored the prognostic factors of KS-specific and non-KS-specific mortality in patients with AIDS-related KS (AIDS-KS), accounting for competing risk.
We identified 17 103 patients with AIDS-KS aged 18-65 years between 1980 and 2016 from the Surveillance, Epidemiology, and End Results (SEER) 18 registry database. Prognostic factors for KS-specific and non-KS-specific mortality were determined by the Fine and Grey proportional subdistribution hazard model. We built competing risk nomograms and assessed their predictive performance based on the identified prognostic factors.
In total, 12 943 (75.68%) patients died, 1965 (15.50%) of whom died from competing events. The KS-specific mortality rate was 14 835 per 100 000 person-years, and the non-KS specific mortality rate was 2719 per 100 000 person-years. Specifically, age >44 years was associated with an 11% decrease in the subdistribution hazard of KS-specific mortality compared with age <43 years but a 50% increase in the subdistribution hazard of non-KS-specific mortality. Being male was associated with a 26% increase in the subdistribution hazard of KS-specific mortality compared with being female but a 32% decrease in the subdistribution hazard of non-KS-specific mortality. Notably, being in the antiretroviral therapy (ART) era consistently showed a decrease in the subdistribution hazard of both KS-specific and non-KS-specific mortality than being in the pre-ART era.
Competing events commonly occurred among patients with AIDS-KS, which deserves further attention to improve the prognosis of these patients.
尽管艾滋病合并卡波西肉瘤（KS）患者的生存率有所提高，但竞争事件仍是影响此类患者生存的一个不可忽视的问题。在本研究中，我们探讨了艾滋病相关KS（AIDS-KS）患者KS特异性和非KS特异性死亡率的预后因素，并考虑了竞争风险。
我们从监测、流行病学和最终结果（SEER）18登记数据库中识别出1980年至2016年间17103例年龄在18至65岁之间的AIDS-KS患者。通过Fine和Grey比例子分布风险模型确定KS特异性和非KS特异性死亡率的预后因素。我们构建了竞争风险列线图，并根据确定的预后因素评估其预测性能。
共有12943例（75.68%）患者死亡，其中1965例（15.50%）死于竞争事件。KS特异性死亡率为每10万人年14835例，非KS特异性死亡率为每10万人年2719例。具体而言，与年龄<43岁相比，年龄>44岁与KS特异性死亡率的子分布风险降低11%相关，但与非KS特异性死亡率的子分布风险增加50%相关。与女性相比，男性与KS特异性死亡率的子分布风险增加26%相关，但与非KS特异性死亡率的子分布风险降低32%相关。值得注意的是，与抗逆转录病毒治疗（ART）前时代相比，处于ART时代始终显示KS特异性和非KS特异性死亡率的子分布风险均降低。
竞争事件在AIDS-KS患者中普遍发生，这值得进一步关注以改善这些患者的预后。
