Retrospective Analysis of the Management of Kaposi’s Sarcoma: Single-Center Experience

Introduction: Kaposi’s sarcoma (MK) is most likely caused by human herpes virus type 8 (HHV-8) which develops particularly in individuals infected with HIV. This disease causes purplish or brownish tumors on the skin. Other organs can be affected, such as the mucous membranes, and the viscera. The goal of our study is to describe the epidemiological, clinical and therapeutic profile of this disease. Chemotherapy has big interest in Kaposi sarcoma. Methodology: This is a retrospective study conducted in the Medical Oncology Department at University Hospital Hassan II Center of FES about 13 patients over a period of 9 years from January 2010 to December 2018 to illustrate the service’s experience in the management of Kaposi’s sarcoma. Results: The annual incidence of Kaposi disease in our department was very low, not exceeding three cases per year during the period studied. We have noted a male predominance with a sex ratio of 3,33. In our study, classical Kaposi disease was the most common form and presented in almost all patients with skin lesion in the form of papulonodules or purplish erythematous-angiomatous plaques. At the time of diagnosis, two patients had stage III and eleven patients had stage IV with visceral involvement according to the KRIEGEL classification. Chemotherapy was the standard treatment for almost all of our patients, other treatments such as surgery or radiotherapy were used in localized disease. The median progression-free survival of Kaposi disease treated in our department is 12 months and the average global survival of the Kaposi sarcoma extends to 52.95% over a 20-month follow-up. Conclusion: In our department, we mostly found the classic form of Kaposi disease. Chemotherapy takes an essential place in the management of advanced cases. Better knowledge of signaling voices allowed the discovery of other therapeutic targets that may be promising in the future.


Introduction
Kaposi's sarcoma is a tumor associated with infection with the human herpes virus 8 (HHV8) which develops particularly in individuals infected with HIV. This disease causes the appearance of purplish or brownish tumors on the skin. Other organs can be affected, such as the mucous membranes, and the viscera. diagnosis and having done additional examinations to establish a classification and an extension assessment, and excluding patients who don't respond to the inclusion criteria or have incomplete data.
The data was collected through the archived paper files and the computer system of the Hassan II University Hospital (Hosix.net) to be recorded on an exploitation sheet and analyzed by the software (Microsoft office Excel) and the SPSS21 software of epidemiology.
Quantitative variables were expressed as average ± standard deviation and qualitative variables as percent. Survival analysis is established using the Kaplan-Meir method.

Results and Discussion
Thirteen files of patients with Kaposi's disease were collected in the patient register of the medical oncology department at the Hassan II Hospital Center in Fez. The analysis of the data collected led to the following results:

Epidemiological data
The male sex was predominant with 10 men (76.9%) for 3 women (23.1%), the patients had a median age of 65 years with a standard deviation of 18.315 and extremes ranging from 27 to 87 years. All of our patients are Moroccan, none of the patients had a sub-Saharan origin.
Kaposi's disease is particularly very rare, this is shown by the very minimal annual incidence of this cancer at the medical oncology department of Fez.

Clinical study
In our study, the most frequent clinical form was classical Kaposi disease with a percentage of 84.6% in eleven HIV negative patients. Patients were evaluated according to performance status based on the OMS classification, which is used to rate patients according to their activity level. The assessment is established upon confirmation of the diagnosis. In our series, two patients had an OMS of 0, ten patients had an OMS of 1 and another patient had an OMS of 2. Kaposi's disease in our series was not associated with

Paraclinical study
The most common used radiological examination was the thoraco-abdominopelvic (TAP) scan, which was performed in all patients to search for secondary locations. Among the lesions found, the most frequent were pulmonary involvement in ten patients (76.9%) mainly represented by pulmonary micronodules. FOGD

Survival analysis
The median progression-free survival for kaposi disease treated in our department is 12 months. On a follow-up of 20 months, the mean overall survival of the disease is extended to 52.95%, the 5-year survival reaches 66.7%.

Discussion
With around 42,000 new cases and 20,000 deaths, Kaposi's sarcoma (SK) is a relatively rare cancer worldwide but is endemic in several countries in southern and eastern Africa and believed to be the leading cause of incidence and cancer mortality in 2018 in Malawi, Mozambique, Uganda and Zambia.
Kaposi's sarcoma is grouped into four epidemiological forms [1]: classic SK affecting elderly men of Mediterranean or Eastern European Jewish descent, endemic SK, existing in parts of central and eastern Africa, described well before the HIV pandemic and often affecting children with disseminated lymphadenopathy [2][3][4], iatrogenic KS, developing in immunocompromised individuals after organ transplantation, for example [5], and AIDS (acquired immune deficiency syndrome) related kaposi sarcoma or AIDS-SK.
In the western world, AIDS-SK mainly affects gay men infected with HIV. However, in Africa, since the spread of HIV, the KS epidemic has become more common in both sexes, with a dramatic decline in the ratio of males to females, particularly in East Africa [6].  Usually, the involvement of the digestive tract is asymptomatic; however, in more advanced stages, lesions in the upper digestive tract can cause digestive symptoms [12].

4.
Kaposi's disease (KD) after iatrogenic immunosuppression: Complications after organ transplants are frequent and varied, mainly related to induced immunosuppression. The risk of cancer is greatly increased in transplant recipients, more particularly viro-induced cancers such as Epstein-Barr virus (EBV) lymphoproliferations, cancers associated with human papillomaviruses. KD accounts for 11.2% of neoplasias, and appears faster than most other cancers, with the average time between transplantation and onset of KD being 20 months [13]. or, probably better, Taxanes will be reserved for forms which have escaped the aforementioned treatments or in the event of dyspneic pulmonary locations [17]. In the absence of antiretroviral treatment, the progression is rapidly progressive towards a multisystem form, associated with opportunistic infections that should be systematically sought out [10]. In the classic form of Kaposi disease, of slow evolution and predominantly cutaneous determinism, localized for a long time and which mainly affects elderly subjects, the vital prognosis is only rarely threatened in the short or medium term in a direct way by the kaposi disease. The treatment will then aim to correct functional or aesthetic damage.

Conclusion
Kaposi's disease (or Kaposi's sarcoma) can be defined as a