Kaposi’s sarcoma: a 10-year experience with 248 patients at a single tertiary care hospital in Tanzania

Abstract

BackgroundKaposi’s Sarcoma is the most common sarcoma and second most prevalent cancer seen in Tanzania. Little is known about Kaposi’s sarcoma in our setting as there is paucity of recent published data regarding this condition. This study describes the clinicopathological pattern and treatment outcome of Kaposi’s sarcoma at Bugando Medical Centre, a tertiary care hospital in northwestern Tanzania.MethodsThis was a prospective study of histologically confirmed Kaposi’s sarcoma that was conducted at Bugando Medical Center between July 2004 and June 2014.ResultsA total of 248 patients (M:F = 1.4:1) representing 2.4 % of all malignancies during the study period were enrolled into the study. The median age at presentation was 36 years. Females were younger than males (p = 0.04). Out of 248 patients, 122 (49.2 %) were HIV positive. Of these, 46 (37.7 %) were males and 76 (62.3 %) females. AIDS-related Kaposi’s sarcoma were younger than HIV negative Kaposi’s sarcoma patients (p = 0.011). Median duration of symptoms was 6 months. Kaposi’s sarcoma was the AIDS defining disease in 82 (67.2 %) patients while in the remaining 40 (32.8 %) it was diagnosed between 1 and 14 months after the initial diagnosis of AIDS. The lower limb was most frequently involved site in 28.9 % of patient. Females had more disseminated lesions compared with more localized lesions in the males (p = 0.001). The treatment modalities in this study included chemotherapy, radiotherapy, surgery and highly active antiretroviral therapy. Overall 126 (53.4 %) patients had significant improvement in quality of life at the end of 1 year follow up. Treatment related complication and mortality rates were 25.8 and 24.2 % respectively. Poor ACTG stage, CD4+ count <200 cells/µl, associated co-morbid illness, disseminated disease and poor adherent to chemotherapy were the significant independent factors associated with deaths (p < 0.001). Patient’s follow-up was generally poor and data on long-term survivals were not available as more than two-thirds of patients were lost to follow up.ConclusionKaposi’s sarcoma is the most common malignant vascular tumor and HIV/AIDS- related cancer in our region. There is an urgent need to develop health education programmes to enhance the understanding of this disease and how it spreads, particularly among the younger generation.

Epidemiological and Clinical Patterns of Kaposi Sarcoma: A 16-Year Retrospective Cross-Sectional Study from Yaoundé, Cameroon

“…On the other hand, we found that affected women were significantly younger than affected men (34.7 vs. 40.4 years; p < 0.001); this result is similar to findings from Enow Orock et al [14] (36.1 vs. 42.4 years) and from Chalya et al [16] (28 vs. 37 years). This might be because the women probably got infected by HIV at a younger age than the men; furthermore, the immunosuppression caused by HIV infection and KS's pathogenesis may progress more rapidly in women than in men [16]. It is worth highlighting that the majority were young adults, with 76.3% of the patients aged less than 45 years.…”

“…This difference could be explained by the fact that the latter studies considered both patients affected by endemic KS and those affected by epidemic KS, endemic KS being more frequent among men [3,20]. On the other hand, we found that affected women were significantly younger than affected men (34.7 vs. 40.4 years; p < 0.001); this result is similar to findings from Enow Orock et al [14] (36.1 vs. 42.4 years) and from Chalya et al [16] (28 vs. 37 years). This might be because the women probably got infected by HIV at a younger age than the men; furthermore, the immunosuppression caused by HIV infection and KS's pathogenesis may progress more rapidly in women than in men [16].…”

“…The slight difference we observed between men and women coincides with other reports from Cameroon [14], South Africa [15], and Tanzania [16]. In some other studies, men were even twice to thrice more numerous than women [17][18][19].…”

“…The seemingly high prevalence of human herpesvirus 8 among the Bantus when compared to the other ethnic groups in Cameroon could explain the higher frequency of KS within this ethnic group considering the close relationship between this virus and KS [22]. Comorbidities such as buccal candidiasis, tuberculosis, and prurigo were common in this study; this observation was also made by other authors [3,15,16].…”

“…Therefore, this finding highlights the vital necessity and importance of screening patients diagnosed with KS for HIV infection. The median duration of the disease was 14 months (IQR 7.5-39), which is different from the 6 months (IQR 4-8) reported by Chalya et al [16]. This discrepancy could be explained by the assumption that our patients had had recourse to traditional pharmacopeia initially, then had had consultations at primary health care centers before reaching the reference hospital, by which time complications had already occurred.…”