Prognostic index for risk of progression of Kaposis Sarcoma
Simon Collins, HIV i-Base
Mark Bower and colleagues from the Chelsea and Westminster Hospital London, presented a prognostic score for patients diagnosed with Kaposis Sarcoma (KS), derived from analysing covariates predictive of overall survival in a cohort of 326 HIV+ patients who developed KS since 1996.
The score in these patients, ranged from 0 to 15 and was calculated starting at the number 10. It incorporated:
- S stage – other ADI: +3 (any other HIV-related illness)
- age: +2 (if >50 years old at diagnosis)
- KS as first ADI: -2 (if KS is the ADI), and
- CD4 cell count: -1 (per 100 cells/mm3 at diagnosis)
Individuals with a prognostic score of 0, 5, 10 and 15, had 1 year survivals of 99.4%, 96.7%, 83.4% and 37.8% and 5 year survivals of 98.4%, 91.8%, 63.1% and 8.4% respectively. Increasing the prognostic score by 1 increased the risk of death by 40% (HR 1.4, 95% CI 1.28-1.53, bootstrapped HR 1.39, 95% CI 1.25-1.51) and the index has a concordance of 76.8% (95% CI 71.7-82.3%). The prognostic index, validated internally using a bootstrap procedure with resampled data, applied to individuals on and off HAART at KS diagnosis.
The study concluded that this score can be used to guide therapeutic options.
Bower M, Sanitt A, Mazhar D et al. A prognostic index for AIDS-associated Kaposi Sarcoma in the era of highly active antiretroviral therapy. Poster abstract TUPE0046.