Cargando…

Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis

BACKGROUND: The taxonomy of Kaposi Sarcoma (KS) is based on a classification system focused on the description of clinicopathological features of KS in geographically and clinically diverse populations. The classification includes classic, endemic, epidemic/HIV associated and iatrogenic KS, and KS i...

Descripción completa

Detalles Bibliográficos
Autores principales: Openshaw, M. R., Gervasi, E., Fulgenzi, C. A. M., Pinato, D. J., Dalla Pria, A., Bower, M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142155/
https://www.ncbi.nlm.nih.gov/pubmed/37106396
http://dx.doi.org/10.1186/s12967-023-04130-6
_version_ 1785033547094949888
author Openshaw, M. R.
Gervasi, E.
Fulgenzi, C. A. M.
Pinato, D. J.
Dalla Pria, A.
Bower, M.
author_facet Openshaw, M. R.
Gervasi, E.
Fulgenzi, C. A. M.
Pinato, D. J.
Dalla Pria, A.
Bower, M.
author_sort Openshaw, M. R.
collection PubMed
description BACKGROUND: The taxonomy of Kaposi Sarcoma (KS) is based on a classification system focused on the description of clinicopathological features of KS in geographically and clinically diverse populations. The classification includes classic, endemic, epidemic/HIV associated and iatrogenic KS, and KS in men who have sex with men (MSM). We assessed the medical relevance of the current classification of KS and sought clinically useful improvements in KS taxonomy. METHODS: We reviewed the demographic and clinicopathological features of 676 patients with KS, who were referred to the national centre for HIV oncology at Chelsea Westminster hospital between 2000 and 2021. RESULTS: Demographic differences between the different subtypes of KS exist as tautological findings of the current classification system. However, no definitive differences in clinicopathological, virological or immunological parameters at presentation could be demonstrated between the classic, endemic or MSM KS patients. Reclassifying patients as either immunosuppressed or non-immunosuppressed, showed that the immunosuppressed group had a significantly higher proportion of adverse disease features at presentation including visceral disease and extensive oral involvement, classified together as advanced disease (chi(2) P = 0.0012*) and disseminated skin involvement (chi(2) P < 0.0001*). Immunosuppressed patients had lower CD4 counts, higher CD8 counts and a trend towards higher HHV8 levels compared to non-immunosuppressed patients, however overall survival and disease specific (KS) survival was similar across groups. CONCLUSION: The current system of KS classification does not reflect meaningful differences in clinicopathological presentation or disease pathogenesis. Reclassification of patients based on the presence or absence of immunosuppression is a more clinically meaningful system that may influence therapeutic approaches to KS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12967-023-04130-6.
format Online
Article
Text
id pubmed-10142155
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-101421552023-04-29 Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis Openshaw, M. R. Gervasi, E. Fulgenzi, C. A. M. Pinato, D. J. Dalla Pria, A. Bower, M. J Transl Med Research BACKGROUND: The taxonomy of Kaposi Sarcoma (KS) is based on a classification system focused on the description of clinicopathological features of KS in geographically and clinically diverse populations. The classification includes classic, endemic, epidemic/HIV associated and iatrogenic KS, and KS in men who have sex with men (MSM). We assessed the medical relevance of the current classification of KS and sought clinically useful improvements in KS taxonomy. METHODS: We reviewed the demographic and clinicopathological features of 676 patients with KS, who were referred to the national centre for HIV oncology at Chelsea Westminster hospital between 2000 and 2021. RESULTS: Demographic differences between the different subtypes of KS exist as tautological findings of the current classification system. However, no definitive differences in clinicopathological, virological or immunological parameters at presentation could be demonstrated between the classic, endemic or MSM KS patients. Reclassifying patients as either immunosuppressed or non-immunosuppressed, showed that the immunosuppressed group had a significantly higher proportion of adverse disease features at presentation including visceral disease and extensive oral involvement, classified together as advanced disease (chi(2) P = 0.0012*) and disseminated skin involvement (chi(2) P < 0.0001*). Immunosuppressed patients had lower CD4 counts, higher CD8 counts and a trend towards higher HHV8 levels compared to non-immunosuppressed patients, however overall survival and disease specific (KS) survival was similar across groups. CONCLUSION: The current system of KS classification does not reflect meaningful differences in clinicopathological presentation or disease pathogenesis. Reclassification of patients based on the presence or absence of immunosuppression is a more clinically meaningful system that may influence therapeutic approaches to KS. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12967-023-04130-6. BioMed Central 2023-04-27 /pmc/articles/PMC10142155/ /pubmed/37106396 http://dx.doi.org/10.1186/s12967-023-04130-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Openshaw, M. R.
Gervasi, E.
Fulgenzi, C. A. M.
Pinato, D. J.
Dalla Pria, A.
Bower, M.
Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis
title Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis
title_full Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis
title_fullStr Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis
title_full_unstemmed Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis
title_short Taxonomic reclassification of Kaposi Sarcoma identifies disease entities with distinct immunopathogenesis
title_sort taxonomic reclassification of kaposi sarcoma identifies disease entities with distinct immunopathogenesis
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10142155/
https://www.ncbi.nlm.nih.gov/pubmed/37106396
http://dx.doi.org/10.1186/s12967-023-04130-6
work_keys_str_mv AT openshawmr taxonomicreclassificationofkaposisarcomaidentifiesdiseaseentitieswithdistinctimmunopathogenesis
AT gervasie taxonomicreclassificationofkaposisarcomaidentifiesdiseaseentitieswithdistinctimmunopathogenesis
AT fulgenzicam taxonomicreclassificationofkaposisarcomaidentifiesdiseaseentitieswithdistinctimmunopathogenesis
AT pinatodj taxonomicreclassificationofkaposisarcomaidentifiesdiseaseentitieswithdistinctimmunopathogenesis
AT dallapriaa taxonomicreclassificationofkaposisarcomaidentifiesdiseaseentitieswithdistinctimmunopathogenesis
AT bowerm taxonomicreclassificationofkaposisarcomaidentifiesdiseaseentitieswithdistinctimmunopathogenesis