815 AIDS-related Kaposi's Sarcoma in 211 Patients: Assessment of the AIDS Clinical Trial Group Staging Classification Prognostic Value in the Era of HAART G. Nasti*1, R. Talamini1, A. Antinori2, F. Martellotta1, M. Fasan3, F. Chiodo4, G. Ballardini5, L. Stoppini6, G. Di Perri7, M. Mena8, M. Tavio1, E. Vaccher1, A. D'Arminio Monforte3, U. Tirelli1 1Ctr di Riferimento Oncologico, Aviano, Italy; 2Inst di Ricovero e Cura a Carattere Sci (IRCCS) Spallanzani, Roma, Italy; 3Hosp Sacco, Milano, Italy; 4Policlinico S Orsola, Bologna, Italy; 5Hosp St Croce, Ravenna, Italy; 6Hosp Civile, Pesaro, Italy; 7Hosp Amedeo di Savoia, Torino, Italy; and 8Hosp di Cuggiono, Italy
Background: To date, no study has focused on the assessment of prognostic factors since the introduction of HAART. In particular, we do not know whether the ACTG staging system for AIDS-related KS is still appropriate and useful to predict survival in the era of HAART.
Methods: To assess potential new prognostic factors and to validate the AIDS Clinical Trials Group (ACTG) for AIDS-related Kaposiís sarcoma (AIDS-KS) staging system in the era of highly active antiretroviral therapy (HAART). We collected epidemiological, clinical, staging, and survival data from 211 patients (pts) with AIDS-KS enrolled in 2 prospective Italian HIV cohort studies: the Italian Cooperative Group on AIDS and Tumors (GICAT) and the Italian Cohort of pts naive from antiretrovirals (ICONA). We included in the analysis all pts with the diagnosis of KS from January 1996, time in which HAART became available in Italy.
Results: One hundred and ninety (190) pts were males and 123 pts (59%) were > 35-years-old with a median age at KS diagnosis of 37 yrs (range 20-80). In the univariate analysis, survival was not influenced by sex, age, level of HIV-viraemia at KS diagnosis, HAART at KS diagnosis (HAART-naÔve vs HAART-experienced), type of HAART combination, or response to CT and/or HAART. As regards ACTG classification, the 3-yr survival rate was 85% for T0 pts and 69% for T1 pts (p = 0.007), 83% for S0 pts, 63% for S1 pts (p = 0.003), 83% for 10 pts, and 71% for 11 pts (p = 0.06). In the multivariate analysis, only the combination of poor tumor stage (T1) and poor systemic disease (S1) risk identifies pts with unfavorable prognosis. The 3-yr survival rate of pts with T1S1 was 53%, which was significantly lower compared to the 3-yr survival rates of pts with T0S0, T1S0, and T0S1 that were 88%, 80%, and 81%, respectively (p = 0.0001). The median survival for pts with T1S1 was 38 months, whereas the median survival for pts with T0S0, T1S0, and T0S1 has not yet been reached.
Conclusions: In the era of HAART, a refinement of the original ACTG staging system is needed. CD4 level does not seem to provide prognostic information. Two (2) different risk categories are identified: a good risk (T0S0, T1S0, and T0S1) and a poor risk (T1S1) group.