Trends in Kaposi's Sarcoma in Miami Beach From 1987–2007

Kaposi's sarcoma (KS) is a rare low-grade vascular tumor associated with the human herpes virus 8 (HHV-8). The demographics, epidemiology, diagnosis, and treatment for Kaposi's sarcoma changed significantly over the past 30 years with the spread of the HIV/AIDS epidemic in the early 1980s, the widespread introduction of combination highly active anti-retroviral treatment (HAART) in the mid 1990s, and finally the advanced aging of the United States population seen in the 2000s. Our Miami Beach community had a very unique position during this time span: It served an extensive elderly population while also serving a population that was one of the epicenters for the HIV/AIDS epidemic in the United States.

Upon review of the Mount Sinai Medical Center tumor registry database in Miami Beach, FL, 143 cases of KS were identified between January 1^st 1987 and December 31^st 2007. Descriptive statistics were used to characterize the demographic and background variables. The Kaplan-Meier and Cox proportional hazard statistical methods were used to estimate overall survival and clinical variables. A chart review was performed for confirmation of CD4 counts.

Of the 143 KS patients identified in the database, the majority were non-Hispanic white (60.1%) non-smoking (42.7%) males (90.2%) diagnosed between 1987–1996 (57.3%). More than half of our study population was HIV positive (52.4%), with an equal percentage of patients diagnosed with local or distant disease (40.6%), and most of the patients receiving no chemotherapy (80.4%) or radiation (65%). The overall survival at 5 years was 27% with a median survival time of 24 months. No significant differences in survival were observed among patients based on sex, age at diagnosis, or treatment received. There was a trend towards improved survival among current smokers and patients presenting with local versus distant disease stage. Multivariate analysis and analysis of maximum likelihood estimates revealed that among patients with KS, Hispanic whites were significantly less likely to die than non-Hispanic whites (HR=0.47, 95% CI=(0.29, 0.78), p=0.003). Patients diagnosed between 1997–2007 had a significantly longer survival than those diagnosed between 1987–1996 (HR=0.38 (95% CI 0.24, 0.60), p<0.0001).

The majority of KS patients identified through our database were young, non-smoking, HIV positive, non-Hispanic white males diagnosed during the peak of the HIV epidemic between 1987 and 1996. Hispanic patients diagnosed with KS during this time period had superior outcomes when compared to non-Hispanic whites. Patients diagnosed from 1997–2007 had superior outcomes when compared to those diagnosed from 1987–1996. There was a trend toward a significance difference in survival among patients based on smoking status and tumor stage at diagnosis. There were no significant differences in survival among patients based on sex, age, or treatment received.

No relevant conflicts of interest to declare.