title: Localised angiosarcomas: the identification of prognostic factors and analysis of treatment impact. A retrospective analysis from the French Sarcoma Group (GSF/GETO).
abstract: BACKGROUND
  Angiosarcomas represent less than 2% of all adult soft tissue sarcomas. Prognostic factors and the role of (neo-) adjuvant treatments in the management of localised angiosarcomas require further investigation.
  
  
  METHODS
  We have conducted a retrospective multicenter study (June 1980 to October 2009) of 107 patients with localised angiosarcomas. All of the cases were centrally reviewed by a certified pathologist. Univariate and multivariate analyses were conducted to identify independent poor prognostic factors (PF). Overall survival (OS) and Local Recurrence-Free Survival (LRFS) were estimated using the Kaplan-Meier method. The effect of treatments was explored using the Cox model after adjusting for the PF.
  
  
  RESULTS
  The median age was 71 years. 22.4% and 62.6% developed an angiosarcoma in pre-existing lymphoedema and within irradiated tissue respectively. The median OS, LRFS and Disease Recurrence-Free Survival (DRFS) were 38.8, 27 and 36.1 months, respectively. In multivariate analysis, the following parameters influenced the OS: lymphoedema (Hazard ratio (HR)=2.0) and size >5cm (HR=1.5). After adjustment to these PF, R0 margins was the only treatment parameter that improving the OS (HR=0.2). In the multivariate analysis, the LRFS was influenced by an age >70 (HR=1.8) and pre-existing lymphoedema (HR=2.0). After adjustment for these PF, R0 margins (HR=0.5) and adjuvant radiotherapy (HR=0.3) improved the LRFS.
  
  
  CONCLUSIONS
  Our results suggest the following points: (i) pre-existing lymphoedema, tumour size and age >70 are probably the major prognostic factors in patients with localised angiosarcomas; (ii) the achievement of R0 margins is probably of major importance for improving the patient outcome and (iii) adjuvant radiotherapy probably decreased the risk of local recurrence.
authors.affiliation: Department of General Oncology, Oscar Lambret Cancer Center, Lille, France.
authors.forename: Clothilde
authors.initials: C
authors.lastname: Lindet
authors.forename: Agnès
authors.initials: A
authors.lastname: Neuville
authors.forename: Nicolas
authors.initials: N
authors.lastname: Penel
authors.forename: Marick
authors.initials: M
authors.lastname: Lae
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Michels
authors.forename: Martine
authors.initials: M
authors.lastname: Trassard
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
authors.forename: Isabelle
authors.initials: I
authors.lastname: Birtwisle-Peyrottes
authors.forename: Isabelle
authors.initials: I
authors.lastname: Valo
authors.forename: Françoise
authors.initials: F
authors.lastname: Collin
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Chateau
authors.forename: Yves-Marie
authors.initials: YM
authors.lastname: Robin
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Coindre
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France; D006394:Hemangiosarcoma / Q000188:drug therapy / Q000473:pathology* / Q000628:therapy*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008209:Lymphedema / Q000473:pathology; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult