Clinical Outcomes and Prognostic Factors of Kaposi Sarcoma in a Non-Endemic Region: A Retrospective Cohort Study

Background: Kaposi sarcoma (KS) is an unusual disease that presents in various clinical forms, leading to variable treatment plans. In this study, we present our center’s experience with the diagnosis and management of KS in a non-endemic area, aiming to highlight the distinctive characteristics of this disease in our locality. Methods: This is a retrospective study that included all patients with KS who presented to our center between January 2008 and December 2025. The epidemiological, clinical, therapeutic, and prognostic data were analyzed. Given the limited number of events, all survival and regression analyses were exploratory and hypothesis-generating. Results: A total of 56 patients with KS (predominantly male: 46/56, 82.1%) were included in the study. The median age at diagnosis was 61 years. HIV seropositivity was documented in 13 patients (23.6%), HCV in 11 (21.2%), and HBV in one patient (1.9%). Nodular morphology was the most common presentation, followed by plaque-type and patch-stage. More than 50 lesions were observed at presentation in 25 patients. The median largest tumor diameter was 2.0 cm (range: 0.5–30.0 cm). Systemic chemotherapy was administered to 29 patients (51.8%), representing the most common initial approach. Surgical excision alone was performed in 13 patients (23.2%), radiotherapy alone in 3 (5.4%), cryotherapy alone in 2 (3.6%), and intralesional chemotherapy in 2 (3.6%). Local recurrence occurred in 12.5% of patients, with the median time to recurrence of 17 months, and positive lymph node status at diagnosis was the only variable associated with local recurrence in exploratory univariate analysis. Metastatic disease developed in 16.1% of patients, with a median time to metastasis of 10 months, and nodular lesion morphology and Ki-67 proliferation index were associated with metastasis in exploratory multivariate analysis. At a median follow-up of 40 months, 9 deaths (16.1%) were recorded. HIV-positive status was associated with worse overall survival (OS). These findings require validation in larger, adequately powered cohorts. Conclusion: While KS generally shows an indolent behavior, exploratory analysis suggests that nodular morphology, high Ki-67, lymph node involvement, and HIV seropositivity may be associated with worse outcomes. Systemic therapy remains the most frequently used treatment for advanced disease, while surgery and radiotherapy are appropriate options for selected localized lesions. These findings should be considered hypothesis-generating and require confirmation in larger, prospective, multicenter studies.