title: Investigation of Prognostic Features in Primary Cutaneous and Soft Tissue Angiosarcoma After Surgical Resection: A Retrospective Study.
abstract: Primary cutaneous and soft tissue angiosarcoma is a rare but highly aggressive malignancy. To date, surgical resection is the mainstay of treatment, but poor prognosis is expected. To investigate whether there are factors associated with poor prognosis after surgical resection and to develop a treatment guideline for current therapy, we retrospectively collected data on 28 patients who underwent surgery as initial treatment and reviewed patient demographics, tumor characteristics, disease courses, and prognoses from September 1996 to May 2013. Of these 28 patients, 17 (60.7%) were men and the mean age at first diagnosis was 66.57 ± 18.57 years. Anatomically, 17 (60.7%) tumors were in the scalp and 11 (39.3%) were in other sites of the body. Of the 28 patients, 23 (82.1%) had achieved negative surgical margins, 24 (85.7%) received adjuvant radiation therapy, and 17 (60.7%) received adjuvant chemotherapy. Twenty-one patients (75%) died during a mean follow-up time of 35.86 ± 28.91 months, and all deaths were caused by angiosarcoma. The 5-year overall survival rate was 17.86%. Sixteen (57.1%) patients had locoregional tumor recurrence, and 20 (71.4%) had distant metastases, with a median of 9.17 (range, 1.9-98.07) months to recurrence or metastasis. Possible predictors of poor prognosis (P < 0.05) in terms of disease-free survival after surgical resection were male sex, cardiovascular disease, smoking, and scalp angiosarcomas, those in terms of overall survival were older than 70 years, male sex, cardiovascular disease, smoking, scalp angiosarcomas, distant metastases, and not receiving adjuvant chemotherapy. In conclusion, although multimodal treatments are used, the overall prognosis after surgical resection is still poor, especially for patients with the above predictive factors. An early diagnosis and complete resection of the primary tumor with or without adjuvant radiotherapy and chemotherapy are suggested for a potential better outcome. For those who have a diffuse lesion pattern with the involvement of vital structures, recurrence, or metastasis, palliative resection could be an alternative treatment choice.
authors.affiliation: From the *Department of Surgery, Veterans General Hospital Yuanshan & Su-Ao Branch; †Division of Plastic Surgery, Department of Surgery, Taipei Veterans General Hospital; ‡Department of Surgery, School of Medicine, National Yang-Ming University, Taipei; §Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center; and ∥Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taiwan, Republic of China.
authors.forename: Biing Luen
authors.initials: BL
authors.lastname: Lee
authors.forename: Cheng-Feng
authors.initials: CF
authors.lastname: Chen
authors.forename: Paul Chih-Hsueh
authors.initials: PC
authors.lastname: Chen
authors.forename: Hui-Chen
authors.initials: HC
authors.lastname: Lee
authors.forename: Wen-Chieh
authors.initials: WC
authors.lastname: Liao
authors.forename: Chern-Kang
authors.initials: CK
authors.lastname: Perng
authors.forename: Hsu
authors.initials: H
authors.lastname: Ma
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Lin
mesh_terms: D000368:Aged; D005260:Female; D006394:Hemangiosarcoma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D000072662:Margins of Excision; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D012983:Soft Tissue Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome