Journal of Clinical Oncology, Vol 12, 1910-1916, Copyright © 1994 by American Society of Clinical Oncology
Improved survival for patients with AIDS-related Kaposi's sarcoma
SA Miles, H Wang, R Elashoff and RT Mitsuyasu
Division Hematology-Oncology, University of California at Los Angeles CARE Center 90024-1793.
PURPOSE: We retrospectively analyzed all patients with AIDS-related
Kaposi's sarcoma (AIDS-KS) seen at one large California medical center to
delineate factors that may have contributed to a relative decline in
survival. METHODS: Potential prognostic factors were analyzed individually,
using the Cox proportional hazards regression model, for their association
with survival. After a stepwise Cox regression procedure was applied to
those factors that showed a significant effect on survival, a subset of
factors that best predicted survival was identified. We then quantified the
effect of the year of diagnosis on survival using a univariate Cox model.
Next, we combined the year of diagnosis with the subset of prognostic
factors previously identified into the Cox model to examine survival after
adjustment for the prognostic factors. Survival distribution was estimated
by the Kaplan- Meier method, and the 95% confidence interval for the median
survival was computed using the modified reflected method. RESULTS: In 688
patients, we identified four baseline variables that best predicted
survival: CD4 cell number, hematocrit, number of KS lesions, and body mass
index (BMI). Adjusted for these predictive factors, there was a significant
improvement in survival for patients with AIDS-KS over the last 6 years.
CONCLUSION: Contrary to prior reports, survival has increased for patients
with AIDS-KS. The apparent increase in observed mortality is most likely
due to a decline in the CD4 cell number at presentation.
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