Disparities in Kaposi sarcoma incidence and survival in the United States: 2000-2013.

Kathryn E Royse,Thomas S Uldrick,Firas El Chaer,Zachary Shepard,Susan E Krown,Elizabeth Y Chiao,Jeannette Y Lee,E Susan Amirian,Christine Hartman,Qiliang Cai

doi:10.1371/journal.pone.0182750

Abstract

ObjectiveGeographic and racial disparities may contribute to variation in the incidence and outcomes of HIV-associated cancers in the United States.MethodUsing the Surveillance, Epidemiology, and End Results (SEER) database, we analyzed Kaposi sarcoma (KS) incidence and survival by race and geographic region during the combined antiretroviral therapy era. Reported cases of KS in men from 2000 to 2013 were obtained from 17 SEER cancer registries. Overall and age-standardized KS incidence rates were calculated and stratified by race and geographic region. We evaluated incidence trends using joinpoint analyses and calculated adjusted hazard ratios (aHR) for overall and KS-specific mortality using multivariable Cox proportional hazards models.ResultsOf 4,455 KS cases identified in men younger than 55 years (median age 40 years), the annual percent change (APC) for KS incidence significantly decreased for white men between 2001 and 2013 (APC -4.52, p = 0.02). The APC for AA men demonstrated a non-significant decrease from 2000–2013 (APC -1.84, p = 0.09). Among AA men in the South, however, APC has significantly increased between 2000 and 2013 (+3.0, p = 0.03). In addition, compared with white men diagnosed with KS during the same time period, AA men were also more likely to die from all causes and KS cancer-specific causes (aHR 1.52, 95% CI 1.34–1.72, aHR 1.49, 95% CI 1.30–1.72 respectively).ConclusionAlthough overall KS incidence has decreased in the U.S., geographic and racial disparities in KS incidence and survival exist.

Highlights

Kaposi sarcoma (KS), a cancer of endothelial cells, is etiologically linked to human herpesvirus 8 (HHV-8)[1], and highly associated with immunosuppression
Of 4,455 KS cases identified in men younger than 55 years, the annual percent change (APC) for KS incidence significantly decreased for white men between 2001 and 2013 (APC -4.52, p = 0.02)
Compared with white men diagnosed with KS during the same time period, AA men were more likely to die from all causes and KS cancer-specific causes

Summary

Introduction

Kaposi sarcoma (KS), a cancer of endothelial cells, is etiologically linked to human herpesvirus 8 (HHV-8)[1], and highly associated with immunosuppression. In parallel with the United States (U.S.) HIV epidemic, the incidence of KS in the U.S peaked in the late 1980s at an age-standardized incidence rate of 33.3 per 100 000 person-years, and subsequently decreased in the late 1990s with the increased availability of combination antiretroviral therapy (ART)[6]. Data from the International Collaboration on HIV and Cancer showed higher age-adjusted incidence rates for both HIV-related and classic KS in U.S metropolitan areas than in rural areas[5]. A Surveillance, Epidemiology, and End Results (SEER) study analyzing the incidence of all cancers in the U.S from 2005 through 2009 showed that KS incidence was positively associated with geographic areas of higher poverty[8]. There have been no studies evaluating the impact of race and geographic region on recent trends in likely AIDS-associated KS incidence

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Results

Conclusion