Two staging systems have been proposed for patients with AIDS-related Kaposi's sarcoma. The AIDS Clinical Trials Group (ACTG) Oncology Committee divides patients into good and poor risk subgroups, while Chachoua et al recognize 4 different grades of disease. These schemes recognize that the prognosis in AIDS patients with Kaposi's sarcoma is linked to the immune status of the patient.
ACTG Staging System
|
|
Good Risk (all of the following) |
Poor Risk (any of the following) |
|
tumor extent |
confined to skin and/or lymph nodes and/or minimal oral disease |
tumor associated edema or ulceration, extensive oral disease, visceral involvement (non-nodal) including GI tract |
|
CD4 count |
>= 200 per µL |
< 200 per µL |
|
opportunistic infection or thrush |
no history |
history of |
|
B symptoms |
absent |
present |
|
Karnofsky score |
>= 70 |
< 70 |
|
other HIV related illnesses |
absent |
present |
Systemic signs (B symptoms):
(1) unexplained 10% weight loss
(2) fever > 100°F (37.8°C) orally, with no identifiable source of infection and lasting > 2 weeks
Other HIV related illnesses include:
(1) malignant lymphoma
(2) neurologic disease
This can be expressed as the tumor extent-immune system-systemic illness (TIS) stage:
|
Parameter |
Finding |
Stage |
|
tumor extent |
good risk |
T0 |
|
|
poor risk |
T1 |
|
immune system |
CD4 count >= 200 per µL |
I0 |
|
|
CD4 count < 200 per µL |
I1 |
|
systemic illness |
good risk (no history of opportunistic infection or thrush, no B symptoms, Karnofsky index >= 70, no other HIV related illnesses) |
S0 |
|
|
poor risk (history of opportunistic infection or thrush, B symptoms present, Karnofsky index < 70 and/or other HIV related illnesses present) |
S1 |
Staging System of Chachoua et al
|
Prior or Coexistent Infections |
Systemic Symptoms |
CD4 count |
Grade |
|
no |
no |
>= 300 per µL |
1 |
|
no |
no |
< 300 per µL |
2 |
|
no |
yes |
NA |
3 |
|
yes |
NA |
NA |
4 |
Specialty: Hematology Oncology, Surgery, general, Infectious Diseases
