Background/Objectives: Kaposi sarcoma (KS) is an HHV-8-associated angioproliferative malignancy with heterogeneous clinical presentation. Early lesions may be overlooked or misattributed to benign conditions, potentially causing diagnostic delay. We evaluated whether diagnostic delay was associated with survival outcomes in a real-world KS cohort. Methods: We retrospectively analyzed 87 consecutive patients with histologically confirmed KS diagnosed between 2007 and 2025. Diagnostic delay was defined as the interval between first patient-reported lesion/symptom recognition documented in medical records and histological diagnosis. An exploratory, maximally selected log-rank method was used to identify the delay cut-off that best separated overall survival (OS). OS and progression-free survival (PFS) were analyzed using Kaplan–Meier estimates, log-rank tests, and Cox regression models. Results: The exploratory optimal cut-off for diagnostic delay was 6.5 months, defining early (≤6.5 months; n = 46) and late (>6.5 months; n = 41) diagnosis groups. Median OS was 202.2 months (95% CI 62.3–342.1) in the early group and 92.9 months (95% CI 61.8–124.0) in the late group (log-rank p < 0.001). Late diagnosis was associated with a higher risk of death (HR 3.6, 95% CI 1.6–8.1; p = 0.001). This association was attenuated after multivariable adjustment and was no longer statistically significant (adjusted HR, 1.711, 95% CI 0.696–4.207; p = 0.242). Patients with late diagnosis were older (median 74 vs. 67 years, p = 0.004), had greater comorbidity burden (39.0% vs. 13.0%; p = 0.005), and more frequently had lymphedema (19.5% vs. 4.3%; p = 0.041). Conclusions: In this single-center KS cohort, longer diagnostic delay was associated with poorer post-diagnosis overall survival in unadjusted analyses, while this association was attenuated after multivariable adjustment. The exploratory 6.5-month threshold identified a subgroup with less favorable survival; however, this data-driven cut-off should be considered hypothesis-generating. These findings support efforts to improve early recognition, biopsy, and referral in KS, particularly in older and more comorbid patients.
Bayrakçı et al. (Sat,) studied this question.