Classic Kaposi's sarcoma in Italy, 1985–1998

Abstract

To evaluate incidence rates (IRs) of classic Kaposi's sarcoma (CKS) in Italy after the spread of AIDS, we distinguished CKS from AIDS-related KS (AKS) using an ‘ad hoc' record linkage procedure between 15 Cancer Registries (CRs) (21% of the Italian population) and the national AIDS Registry. Between 1985 and 1998, 874 cases of CKS and 634 cases of AKS were diagnosed in the study areas. CKS accounted for 16 and 27% of KS cases below 55 years of age in men and women, respectively, but for 91 and 100% of those above age 55. The IRs for CKS were 1.0/ in men and 0.4/100 000 in women, but they varied between 0.3 in Umbria and 4.7 in Sassari in men, and between 0.1 in Parma and 1.7 in Sassari in women. IRs of CKS in both genders were stable between 1985–1987 and 1993–1998. In Northern and Central CRs the IR (adjusted for age and gender) for CKS was 0.5 in individuals born in the same area, but 1.6 in individuals born in Southern Italy or in the Islands (rate ratio=3.2) suggesting that KS-associated herpesvirus, the cause of KS, is acquired early in life.

Cause-specific mortality in classic Kaposi's sarcoma: a population-based study in Italy (1995–2002)

“…However, we can assume that CKS was not advanced, given that there was no mention of advanced disease anywhere on the death certificate. With regard to the length of survival, though this information is not available on death certificates, if we compare the median age at diagnosis in Italy (Dal Maso et al, 2005) to the median age at death in our study, we can roughly calculate that survival is B10 years, which is consistent with previous studies (Brambilla et al, 1994;Franceschi et al, 1996). The geographical analysis showed a wide heterogeneity, though the reasons for the findings are unknown.…”

“…The geographical analysis showed a wide heterogeneity, though the reasons for the findings are unknown. In particular, our results confirmed that being born in southern Italy or the Islands is a risk factor for CKS (Geddes et al, 1995;Dal Maso et al, 2005), and we identified the specific regions in these areas. The results also revealed an excess for persons born in two adjacent provinces in the northern region of Lombardy, which is consistent with the increased incidence of CKS and high HHV8 seroprevalence in another adjacent province (Ascoli et al, 2001;Tanzi et al, 2005).…”

“…To exclude AIDS-related KS deaths, we carried out the following: (i) we eliminated the records with mention of HIV or AIDS anyplace on the death certificate; (ii) we manually reviewed the remaining individual records and excluded those with mention of AIDS-indicator opportunistic infections (WHO, 1994) (steps (i) and (ii) resulted in the elimination of 902 records); and (iii) we excluded all records for persons o65 years of age (n ¼ 89), limiting the analysis to older persons, who have an extremely low prevalence of HIV/AIDS (Dal Maso et al, 2005); in our records, only 4.5% of the decedents with KS and mention of HIV/AIDS were aged X65 years. To exclude transplant-associated KS, we eliminated the records that mentioned transplants (n ¼ 30; 10 with heart transplant, 7 kidney, and 13 liver).…”

Risk of Kaposi's sarcoma and of other cancers in Italian renal transplant patients

“…The short induction period between transplant and KS diagnosis suggests that KS development in transplant patients is associated with a rapid re-activation of latent HHV-8 infection (Andreoni et al, 2001;Cannon et al, 2003). The investigation of geographical factors confirmed a higher (about six-fold) KS risk for individuals born in the South of Italy, as compared to those born in the North Dal Maso et al, 2004). On account of massive South-toNorth migration in Italy in the last decades, 44.3% of our study patients born in the South lived in the North at time of transplant.…”

“…The prevalence of infection with KS-associated herpesvirus (i.e., human Herpesvirus type 8 (HHV-8)) (Whitby et al, 1998;Serraino et al, 2000;Vitale et al, 2001) and the incidence of classic KS Dal Maso et al, 2004) are relatively high in Italy, particularly in the South. The aim of this study was to quantify the excess of KS risk, to identify factors associated with KS occurrence, and also to define the spectrum of cancers associated with immunosuppression in patients from two major Italian transplant centres.…”