Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Ann Surg Oncol. 2020 Aug;27(8):3018-3027. doi: 10.1245/s10434-020-08408-7. Epub 2020 May 26.
The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas.
This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner.
The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes.
For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.
血管肉瘤的淋巴结转移（LNM）发生率据报道低于 15%，因此并未建议选择性颈部管理。本研究通过其全程临床资料评估头皮血管肉瘤患者区域性 LNM 的发生率和模式，以了解头皮血管肉瘤的时间事件序列。
本回顾性研究纳入了所有经病理证实的血管肉瘤连续病例，并分析了 40 例头皮血管肉瘤。使用 Kaplan-Meier 方法估计生存图，结果主要以描述性方式呈现。
患者的总生存率为 2 年时的 35.8%。与以往的报告不同，超过一半（52.5%）的头皮血管肉瘤患者出现区域性 LNM。同时，只有 27.5%的患者发生远处器官的直接扩散。区域性 LNM 可预测 3 至 6 个月内全身性疾病的临床表现。在本系列中，有或没有 LNM 的患者的生存率没有差异。LNM 的发生似乎与原发肿瘤的高有丝分裂率相关，但与肿瘤分级或肿瘤大小无关。头皮血管肉瘤的第一站淋巴结为腮腺旁、耳后和 2 区淋巴结。
对于局限性头皮血管肉瘤，初始根治性手术似乎可以合理地包括预防性评估区域性淋巴结的病理淋巴结分期、预后评估和全身治疗的决策。
