Predictive Clinical Factors in the Diagnosis of Gastrointestinal Kaposi's Sarcoma and Its Endoscopic Severity

Naoyoshi Nagata,Norio Ohmagari,Takuro Shimbo,Naomi Uemura,Shinichi Oka,Toru Igari,Naoki Asayama,Hirohisa Yazaki,Katsuji Teruya,Junichi Akiyama,Jianming Tang

doi:10.1371/journal.pone.0046967

Naoyoshi Nagata, Norio Ohmagari + Show 9 more

Open Access

https://doi.org/10.1371/journal.pone.0046967

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Journal: PloS one	Publication Date: Nov 30, 2012
Citations: 65	License type: CC BY 4.0

Affiliation: National Center for Global Health and Medicine

Abstract

BackgroundThe diagnosis of gastrointestinal (GI) involvement in Kaposi's sarcoma (KS) is important to make because the need for treatment depends on the extent of the disease. Moreover, severe GI lesions can cause serious complications. Endoscopy with biopsy is an extremely useful method to diagnose GI-KS. However, determining the indications for endoscopy is difficult because KS can occur without GI symptoms or cutaneous KS. This study sought to clarify predictive clinical factors for GI-KS and its severity on endoscopy.Methodology/Principal FindingsA total of 1,027 HIV-infected patients who underwent endoscopy were analyzed. Sexual behavior, CD4 count, HIV RNA, history of highly active antiretroviral therapy (HAART), GI symptoms, and cutaneous KS were assessed. Endoscopic severity including bulky tumor, ulceration, and number of lesions were evaluated. Thirty-three patients had GI-KS and 46 patients cutaneous KS. Among the GI-KS patients, 78.8% (26/33) had no GI symptoms and 24.2% (8/33) had no cutaneous KS. Univariate analysis identified men who have sex with men (MSM), CD4 <100 cells/µL, HIV RNA ≥10,000 copies/mL, no history of HAART, and cutaneous KS were significantly associated with GI-KS. Among these factors, cutaneous KS was closely related to GI-KS on multivariable analysis. Among patients without cutaneous KS, MSM and CD4 count <100 cells/µL were the only independent clinical factors related to GI-KS. Bulky tumor was significantly associated with CD4 <100 cells/µL and large number of lesions was significantly associated with HIV-RNA ≥10,000 copies/mL.ConclusionsTo diagnose GI-KS, clinical factors need to be considered before endoscopy. The presence of GI symptoms is not useful in predicting GI-KS. MSM and CD4 count <100 cells/µL are predictive factors among patients without cutaneous KS. Caution should be exercised especially in patients with low CD4 counts or high HIV viral loads as they are more likely to develop severe GI-KS lesions.

Highlights

Kaposi’s sarcoma (KS) is a rare type of cancer of the lymphatic and blood vessels that most commonly involves the skin [1,2,3]
To diagnose GI-KS, clinical factors need to be considered before endoscopy
We found that men who have sex with men (MSM), low CD4 (,100 cells/mL), high HIV RNA viral load (VL) (.10,000 copies/mL), no history of highly active antiretroviral therapy (HAART), and presence of cutaneous KS were predictive clinical factors for GIKS on univariate analysis

Summary

Introduction

Kaposi’s sarcoma (KS) is a rare type of cancer of the lymphatic and blood vessels that most commonly involves the skin [1,2,3]. Endoscopy with biopsy is extremely useful for diagnosing GI-KS and is usually indicated for patients with GI symptoms and the presence of cutaneous KS [17,18]. The indications for endoscopy to detect GI-KS in patients with HIV/ AIDS, especially those without GI symptoms or cutaneous disease, have been difficult to determine. The diagnosis of gastrointestinal (GI) involvement in Kaposi’s sarcoma (KS) is important to make because the need for treatment depends on the extent of the disease. Determining the indications for endoscopy is difficult because KS can occur without GI symptoms or cutaneous KS. This study sought to clarify predictive clinical factors for GI-KS and its severity on endoscopy

Results

Discussion

Conclusion