Department of Radiation Oncology.
Department of Medicine, Division of Medical Oncology, Stanford University School of Medicine.
Am J Clin Oncol. 2020 Nov;43(11):820-825. doi: 10.1097/COC.0000000000000753.
Angiosarcoma of the breast is rare and has a poor prognosis. We reviewed our institution's experience with this disease to characterize presentation, identify management patterns, and report outcomes.
Fifty-eight patients with nonmetastatic angiosarcoma were identified from 1998 to 2019 and retrospectively reviewed. Overall survival (OS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier analysis and log-rank test.
The median follow-up was 43.4 months (range: 1.8 to 203.3 mo). Twenty-four patients had primary angiosarcoma (PAS) and 34 patients had secondary angiosarcoma (SAS). Patients with PAS were significantly younger than those with SAS (P<0.0001). Mastectomy was the main surgical treatment in our cohort (n=47) and 3 underwent a lumpectomy. The multifocal disease was found in 5/23 patients with PAS and 11/35 patients with SAS. Twenty-eight patients received chemotherapy. Radiation was administered to 13 patients with PAS and 3 patients with SAS. Five-year OS was 73.7% for PAS and 63.5% for SAS. Local recurrence occurred in a greater proportion of patients with margins <5 mm than those with margins ≥5 mm. Chemotherapy did not impact RFS and was not associated with OS in PAS (P=0.35). Those with SAS treated with chemotherapy had significantly greater OS than those who did not receive chemotherapy (P=0.043). Radiation did not significantly influence RFS or OS.
Five-year OS was higher than anticipated. Margins >5 mm appear important for local control. Patients with SAS, but not PAS, may achieve improved survival with chemotherapy. National trials using prespecified agents may be needed to identify an optimal chemotherapy regimen for women with SAS.
乳腺血管肉瘤罕见，预后不良。我们回顾了本机构在该疾病方面的经验，以明确其临床表现、确定治疗模式，并报告结局。
1998 年至 2019 年共确定了 58 例非转移性血管肉瘤患者，并对其进行回顾性研究。使用 Kaplan-Meier 分析和对数秩检验计算总生存期（OS）和无复发生存期（RFS）。
中位随访时间为 43.4 个月（范围：1.8 至 203.3 个月）。24 例为原发性血管肉瘤（PAS），34 例为继发性血管肉瘤（SAS）。PAS 患者显著较 SAS 患者年轻（P<0.0001）。在本队列中，47 例患者接受了乳房切除术，3 例患者接受了保乳术。5/23 例 PAS 患者和 11/35 例 SAS 患者存在多发病灶。28 例患者接受了化疗。13 例 PAS 患者和 3 例 SAS 患者接受了放疗。PAS 的 5 年 OS 为 73.7%，SAS 为 63.5%。切缘<5mm 的患者局部复发率高于切缘≥5mm 的患者。在 PAS 中，化疗并未影响 RFS 或 OS（P=0.35）。接受化疗的 SAS 患者 OS 显著长于未接受化疗的患者（P=0.043）。放疗并未显著影响 RFS 或 OS。
5 年 OS 高于预期。切缘>5mm 对局部控制可能很重要。SAS 患者而非 PAS 患者可能受益于化疗，从而改善生存。可能需要使用预设药物进行全国性试验，以确定 SAS 患者的最佳化疗方案。
