|
Stage Information for Kaposi Sarcoma
The staging evaluation of patients with classic Kaposi sarcoma (KS) should be
individualized. The advanced age of most of the patients, localized nature
of the tumor, rarity of visceral involvement, and usually indolent course of
the disease should temper the extent of the evaluation. A careful examination
of the skin and lymph nodes is sufficient in most cases. For the rare
patient with rapidly progressive tumor or signs or symptoms of visceral
involvement, appropriate evaluation is indicated. No universally
accepted classification is available for epidemic KS. Staging schemes that incorporate laboratory parameters as well as clinical features have been proposed. Since
most patients with epidemic KS do not die from the disease, factors besides tumor burden are apparently involved in survival.
The conventions used to stage KS and the methods used to evaluate the benefits
of KS treatment continue to evolve because of changes in
the treatment of HIV and in recognition of deficiencies in standard tumor
assessment. The clinical course of KS, the selection of treatment, and
the response to treatment are heavily influenced by the degree of underlying immune
dysfunction and opportunistic infections.
The AIDS Clinical Trials Group (ACTG) Oncology Committee has published criteria
for the evaluation of epidemic KS.[1] The staging system incorporates
measures of extent of disease, severity of immunodeficiency, and presence of
systemic symptoms. As shown in the table below, the ACTG criteria categorizes the extent of
the tumor as localized or disseminated, the CD4 cell number as high or low, and
a systemic illness as absent or present.
A subsequent prospective analysis of
294 patients entered on ACTG trials for KS between 1989 and 1995 showed that
each of the tumor, immune system, and systemic illness (TIS) variables was
independently associated with survival.[2] Multivariate analysis showed that
immune system impairment was the most important single predictor of survival.
In patients with relatively high CD4 counts, tumor stage was predictive. A CD4
count of 150 cells/mm³ may be a better discriminator than the
published cutoff of 200 cells/mm³. A study is in progress to
determine if viral load adds predictive information. None of the prior studies were conducted at a time when highly active
antiretroviral therapy (HAART) was readily available. The impact of HAART on
survival in KS requires continued assessment.
AIDS Clinical Trials Group Staging Classification
|
|
Good Risk (0)
|
Poor Risk (1)
|
|
(Any of the following)
|
(Any of the following)
|
| Tumor (T) |
Confined to skin
and/or lymph nodes
and/or minimal oral
disease [Note: Minimal oral disease is non-nodular KS confined to the palate.] |
Tumor-associated edema or ulceration |
| Extensive oral KS |
| Gastrointestinal KS |
| KS in other non-nodal
viscera |
| Immune system (I) |
CD4 cells ≥ = 200/microL |
CD4 cells <200 per
cubic millimeter |
| Systemic illness (S) |
No history of OIs or
thrush [Note: OIs are opportunistic infections.]
|
History of OIs and/or thrush |
| No “B” symptoms [Note: “B” symptoms are unexplained fever, night sweats, >10%
involuntary weight loss, or diarrhea persisting >2 weeks.] |
“B” symptoms present |
| Performance status
≥70 (Karnofsky)
|
Performance status
<70 |
| Other HIV-related
illness (e.g.,
neurological disease
or lymphoma) |
References
-
Krown SE, Metroka C, Wernz JC: Kaposi's sarcoma in the acquired immune deficiency syndrome: a proposal for uniform evaluation, response, and staging criteria. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol 7 (9): 1201-7, 1989.
[PUBMED Abstract]
-
Krown SE, Testa MA, Huang J: AIDS-related Kaposi's sarcoma: prospective validation of the AIDS Clinical Trials Group staging classification. AIDS Clinical Trials Group Oncology Committee. J Clin Oncol 15 (9): 3085-92, 1997.
[PUBMED Abstract]
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