Criteria

AIDS Clinical Trials Group Oncology Committee staging system for AIDS-related Kaposi sarcoma[49][50]

Patients are divided into good- or poor-risk groups according to three parameters (TIS):

  • T: Extent of tumor

  • I: Immune status

  • S: Severity of systemic illness.

Although each parameter has been shown to prospectively predict survival, the original validation study of the TIS staging system predated the availability of antiretroviral therapy (ART). One prospective evaluation of this staging system conducted in the ART era showed that only the combination of poor tumor state and poor systemic disease adequately identified patients with unfavorable prognosis.[51]

Universally accepted staging classifications are lacking.[3][5]

The Karnofsky score for clinical evaluation in response to chemotherapy[52]

The Karnofsky clinical evaluation score was first described in 1949 and runs from 0 to 100, where 100 is perfect health and 0 is death:

  • 100%: Normal, no complaints, no signs of disease

  • 90%: Capable of normal activity, few symptoms or signs of disease

  • 80%: Normal activity with some difficulty, some symptoms or signs

  • 70%: Caring for self, not capable of normal activity or work

  • 60%: Requiring some help, can take care of most personal requirements

  • 50%: Requires help often, requires frequent medical care

  • 40%: Disabled, requires special care and help

  • 30%: Severely disabled, hospital admission indicated but no risk of death

  • 20%: Very ill, urgently requiring admission, requires supportive measures or treatment

  • 10%: Moribund, rapidly progressive fatal disease processes

  • 0%: Death.

Staging of classic Kaposi sarcoma[53]

A four-stage system is proposed for classic KS to facilitate therapeutic decision making:

  • I : Maculo-nodular stage with lesions localized to the lower extremity

  • II: Infiltrative stage involving wide areas on the lower limbs

  • III: Florid stage for exuberant, often ulcerated lesions involving one or more limbs

  • IV: Disseminated stage where KS extended to cutaneous sites in addition to the limbs.

Disease progression is additionally scored as slowly evolving (A) or rapidly evolving (B) KS (defined as an increase in the number or total area of lesions in 3 months). Complications (e.g., ulceration, lymphedema, or pain) as well as visceral involvement are also considered.

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