Kaposi Sarcoma: Retrospective Clinical Analysis with a Focus on Age and HIV Serostatus

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Thank you for allowing me to review the article "Kaposi Sarcoma: Retrospective Clinical Analysis with a Focus on Age and HIV Serostatus".

The work is globally well-written. Although this article doesn't add anything new to scientific knowledge, the importance of investigating aspects of Kaposi sarcoma patients is crucial.

I suggest that the authors consider some points:

• Ethical committee approval should be present in the Materials and Methods section.
• Limitations of the study should be clearly listed in the discussion section of the manuscript.

I suggest the authors revise the article to emphasise the single-centre, real-world data experience, as the study has several limitations, first and foremost, the relatively small number of participants.

Author Response

Comments 1: Ethical committee approval should be present in the Materials and Methods section. 

Response 1: Thank you very much for taking time to review this manuscript. We agree with this comment. Therefore we have added "The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Istanbul Medipol University with the protocol code E-10840098-202.3.02-3368 on 28 May 2025." as the first sentence of the Materials and Methods section which can be found on page number 2, first paragraph, line 71, and highlighted the correction in the re-submitted file. 

Comments 2: Limitations of the study should be clearly listed in the discussion section of the manuscript. I suggest the authors revise the article to emphasize the single-centre, real world data experience, as the study has several limitations, first and foremost, the relatively small number of participants. 

Resonse 2: Thank you for pointing this out. We agree with this comment. We have accordingly deleted the last sentence of the discussion section and added these two sentences "The limitations of this study are its single-center design and relatively small sample size. Nevertheless, it provides valuable insights from real-world data and lays the groundwork for future research in this field." on page 9, second paragraph, line 291, and highlighted the correction in the re-submitted file. 

 

Reviewer 2 Report

Comments and Suggestions for Authors

I have reviewed the article: "Kaposi Sarcoma: Retrospective Clinical Analysis with a Focus on Age and HIV Serostatus". I have the following suggestions regarding this study:

1. Providing clinical and histological images of Kaposi sarcoma in their study can improve the manuscript.
2. The limitations of the study need to be discussed (such as cohort size).
3. The entire discussion portion is written in one paragraph. Please consider revising that.
4. Based on the clinical and lab data, it will be useful to know how many Kaposi sarcoma were there in each type (classical, HIV, iatrogenic, etc). Thank you.

Author Response

Comments 1: Providing clinical and histological images of Kaposi sarcoma in their study can improve the manuscript. 

Response 1: Thank you very much for your time to review this manuscript. We agree with this comment. We have provided 2 clinical and 2 histological images of Kaposi sarcoma and downloaded them. Clinical images are in the text as Images 1 and 2 on first page, first paragraph, line 38 and are highlighted. Histological images are in the text as Image 3 and Image 4 on page 3, first paragraph, line 99 and line 100 and are highlighted. 

Comments 2: The limitations of the study need to be discussed (such as cohort size). 

Response 2: Thank you for pointing this out. We agree with this comment. We have accordingly deleted the last sentence of the discussion section and added these two sentences "The limitations of this study are its single-center design and relatively small sample size. Nevertheless, it provides valuable insights from real-world data and lays the groundwork for future research in this field." on page 9, second paragraph, line 291, and highlighted the correction in the re-submitted file. 

Comments 3: The entire discussion portion is written in one paragraph. Please consider revising that.

Response 3: Thank you for pointing this out. We agree with this comment. We have divided the discussion section into six paragraphs. 

Comments 4: Based on the clinical and lab data, it will be useful to know how many Kaposi sarcoma were there in each type (classical, HIV, iatrogenic, etc). 

Response 4: Thank you for pointing this out. We agree with this comment. We have accordingly added two sentences into the discussion section on page 9, first paragraph, line 265. The corresponding revision is as follows: "The patient with Crohn’s disease was a 68-year-old HIV-negative man receiving treatment with mesalazine and azathioprine. The patient with rheumatoid arthritis was an 82-year-old HIV-negative woman receiving treatment with 12.5 mg/week methotrexate and 5 mg/day prednisolone. However, whether these two patients should be classified as having classic or iatrogenic Kaposi sarcoma remains a matter of debate. Based on current knowledge, we classified these two patients as having classical Kaposi sarcoma. Consequently, in our cohort, 24 patients had classical, 3 had iatrogenic, and 6 had HIV-associated Kaposi sarcoma. Further studies are needed to clearly identify which immunosuppressive drugs and dosages are associated with the development of non–transplant-related iatrogenic Kaposi sarcoma." The corresponding revision is highlighted in the re-submitted file.