Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.
Kaposi's sarcoma in AIDS (EKS) patients: proposal for a new staging classification based on TNM-UICC recommendations (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 12:A16 1993. Unique Identifier : AIDSLINE ICDB/93694416 Tambussi G; Torri W; Repetto L; Saracco A; Moresco L; Lazzarin A; Badellino F; Gruppo Italiano di Cooperazione AIDS e Tumori (GICAT), Italy
Abstract:
Objective: several proposals for EKS classification have been made; however,generally accepted criteria are lacking. According to TNM-UICC indications for tumor staging,we propose a new classification system based on a modified Krown's staging which takes into account three major parameters: T, anatomical and morphological features of the lesions; (I) immune system status; S, systemic illness (TIS). Patients (pts) and methods: we analyzed 300 HIV-positive pts with EKS: 277 males: 66.6% homosexual, 14.2% IVDU, 19.2% others; 23 females: 65.2% IVDU, 30.4% partners, 4.3% others collected from the GICAT. Median follow-up was 44 mo (range 1-103); median overall survival was 13 mo; median 5-yr survival was 8%. The median number of CD4 at the time of EKS diagnosis was 122/mm3. All the pts were classified according to the Mitsuyasu system. Moreover, they were retrospectively classified according to the TIS staging: T1 stands for tumor confined to the skin and/or lymph nodes and/or minimal oral disease; T2, tumor-associated edema or ulceration and/or extensive oral KS and/or gastrointestinal or other visceral KS; 10 CD4 count greater than 200 mm3; 11 CD4 less than or equal to 200 mm3; S0 no previous OI or thrush or B symptoms; S1 B symptoms or infectious diseases included in the CDC classification group IV C2; S2 previous OI with or without B symptoms according to CDC classification group IV C1. Survival analyses using log-rank test and Cox multivariate analysis were performed to investigate the prognostic values of Mitsuyasu and TIS staging systems. Results: no survival difference was observed among the pt groups defined by Mitsuyasu staging. Considering the TIS system, tumor extension did not affect the risk of death. Conversely, immune system and systemic illness subgroups were significantly associated with different risks of death: I0S1 and I1S0 pts showed the same relative risk of death 3.9 (CI 1.8-8.7) compared with 10S0 group. I1S1 and I1S2 groups exhibited a relative risk of 8.3 (CI 3.6-19.1). Conclusions: in our series, Mitsuyasu staging failed to show prognostic value. When TIS staging was applied either a low CD4 count or the presence of symptoms have prognostic importance in predicting the survival of pts. When symptoms were associated with a CD4 count less than or equal to 200/mm3 the relative risk of death was even worse. TIS classification is apparently a reliable staging system allowing prognostic information; however, it needs to be further evaluated.
Keywords: Acquired Immunodeficiency Syndrome/CLASSIFICATION/MORTALITY/ *PATHOLOGY Adult Female Follow-Up Studies Human Male Middle Age Neoplasm Staging Sarcoma, Kaposi's/CLASSIFICATION/MORTALITY/*PATHOLOGY Skin Neoplasms/CLASSIFICATION/MORTALITY/*PATHOLOGY Survival Analysis Survival Rate ABSTRACT 931230
M93C0813
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Important note: Information in this article was accurate in 1993. The state of the art may have changed since the publication date.
