Sinnamon Andrew J, Neuwirth Madalyn G, McMillan Matthew T, Ecker Brett L, Bartlett Edmund K, Zhang Paul J, Kelz Rachel R, Fraker Douglas L, Roses Robert E, Karakousis Giorgos C
Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Pathology, University of Pennsylvania, Philadelphia, Pennsylvania.
J Surg Oncol. 2016 Oct;114(5):557-563. doi: 10.1002/jso.24352. Epub 2016 Jul 4.
Angiosarcoma is an aggressive tumor rising in incidence from use of therapeutic radiation. Because of its relative rarity, prognostic factors have not been clearly delineated.
Patients who underwent resection of localized angiosarcoma from 2002 to 2012 were identified using the National Cancer Data Base. Factors associated with poor overall survival (OS) were identified using Cox proportional hazards modeling and internally validated with bootstrap resampling. These were used to construct a risk model to identify low-, intermediate-, or high-risk groups.
Median OS among 821 patients undergoing resection was 3.4 years. On multivariable analysis of factors known preoperatively, those associated with worse OS included: age >70 years (HR 2.02, P < 0.0001), black race (HR 1.92, P < 0.0001), head and neck primary (HR 1.44, P = 0.003), grade 3 tumor (HR 1.53, P = 0.013), size 3-7 cm (HR 1.64, P < 0.0001), size >7 cm (HR 2.37, P < 0.0001). After including postoperative variables, positive resection margins were associated with worse OS (microscopic, HR 1.59, P = 0.002; macroscopic, HR 3.38, P = 0.008). Stratification by risk group was superior to AJCC stage in discriminating OS.
In the largest study to date of patients with angiosarcoma, risk factors for poor OS were identified to create a clinically useful risk model that can prognosticate patients with localized disease following surgical resection. J. Surg. Oncol. 2016;114:557-563. © 2016 Wiley Periodicals, Inc.
血管肉瘤是一种侵袭性肿瘤，因放射治疗的使用而发病率上升。由于其相对罕见，预后因素尚未明确界定。
使用国家癌症数据库确定2002年至2012年接受局限性血管肉瘤切除术的患者。使用Cox比例风险模型确定与总体生存（OS）不良相关的因素，并通过自助重采样进行内部验证。这些因素用于构建风险模型，以识别低、中或高风险组。
821例接受切除术的患者的中位OS为3.4年。对术前已知因素进行多变量分析，与较差OS相关的因素包括：年龄>70岁（HR 2.02，P<0.0001）、黑人种族（HR 1.92，P<0.0001）、头颈部原发肿瘤（HR 1.44，P = 0.003）、3级肿瘤（HR 1.53，P = 0.013）、大小为3 - 7 cm（HR 1.64，P<0.0001）、大小>7 cm（HR 2.37，P<0.0001）。纳入术后变量后，切缘阳性与较差的OS相关（显微镜下，HR 1.59，P = 0.002；肉眼可见，HR 3.38，P = 0.008）。在区分OS方面，按风险组分层优于美国癌症联合委员会（AJCC）分期。
在迄今为止关于血管肉瘤患者的最大规模研究中，确定了OS不良的风险因素，以创建一个临床有用的风险模型，该模型可对手术切除后局限性疾病患者的预后进行预测。《外科肿瘤学杂志》2016年；114：557 - 563。©2016威利期刊公司
