Pawlik Timothy M, Paulino Augusto F, McGinn Cornelius J, Baker Laurence H, Cohen Deborah S, Morris Jeffery S, Rees Riley, Sondak Vernon K
Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA.
Cancer. 2003 Oct 15;98(8):1716-26. doi: 10.1002/cncr.11667.
Angiosarcoma is a malignant tumor of vascular endothelial cells that arises in the head and neck. It is a rare, difficult to treat, and lethal tumor.
Clinical data from patients who were diagnosed with angiosarcoma of the scalp between 1975 and 2002 at the University of Michigan were reviewed. Analysis was performed to assess for factors impacting time to recurrence and survival.
The study was comprised of 29 patients with a median age of 71.0 years. Most patients presented after a delay in diagnosis with either a bruise-like macule (48.3%) or a nonbruise-like nodule (51.7%). Seventy-five percent of patients had pathologic Stage T2 disease, and 76% of patients had high-grade tumors. Virtually all patients underwent surgical excision (96.6%); however, negative surgical margins were achieved in only 21.4% of patients. Multiple lesions on presentation were associated with a shorter time to recurrence (P = 0.02). The median actuarial survival was 28.4 months. Younger patients and patients with Stage T1 disease had improved survival (P = 0.024 and P = 0.013, respectively). Radiation therapy was associated significantly with a decreased chance of death (hazard ratio, 0.16; P = 0.006).
Although surgery remains the first option for the treatment of patients with angiosarcoma of the scalp, achieving negative margins often is impossible. Patients who are younger and who have less extensive disease fare better. Postoperative radiation therapy should be employed routinely, as it may lead to improved survival.
血管肉瘤是一种起源于头颈部的血管内皮细胞恶性肿瘤。它是一种罕见、难以治疗且致命的肿瘤。
回顾了1975年至2002年在密歇根大学被诊断为头皮血管肉瘤患者的临床资料。进行分析以评估影响复发时间和生存的因素。
该研究包括29例患者，中位年龄为71.0岁。大多数患者在诊断延迟后出现，表现为瘀斑样斑疹（48.3%）或非瘀斑样结节（51.7%）。75%的患者病理分期为T2期疾病，76%的患者为高级别肿瘤。几乎所有患者都接受了手术切除（96.6%）；然而，仅21.4%的患者实现了手术切缘阴性。初诊时存在多个病灶与较短的复发时间相关（P = 0.02）。中位精算生存时间为28.4个月。年轻患者和T1期疾病患者的生存率有所提高（分别为P = 0.024和P = 0.013）。放疗与死亡几率显著降低相关（风险比，0.16；P = 0.006）。
尽管手术仍然是头皮血管肉瘤患者治疗的首选，但通常不可能实现切缘阴性。年龄较小且疾病范围较小的患者预后较好。术后应常规进行放疗，因为这可能会提高生存率。
