Bi Siwei, Chen Shanshan, Wu Beiyi, Cen Ying, Chen Junjie
Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Front Oncol. 2021 Feb 25;11:627113. doi: 10.3389/fonc.2021.627113. eCollection 2021.
Cutaneous angiosarcoma (cAS) is an aggressive vascular tumor that originates from vascular or lymphatic epithelial cells. To date, the cAS literature has been limited in a small number with single-center experiences or reports due to its rarity and the optimal treatment strategy is still in dispute. This study aimed to conduct a systematic review and compare the effect of available treatments retrieved from observational studies and Surveillance, Epidemiology, and End Results (SEER) program.
The authors performed a systematic review in the PubMed, Embase and MEDLINE database identifying the researches assessing the treatment for cAS patients. Clinical and treatment information of patients who had been diagnosed with a primary cAS were also obtained from the SEER program.
Thirty-two studies were eligible but only 5 of which with 276 patients were included in meta-analysis since the unclear or unavailable information. The risk ratio of 5-year death for surgery, surgery with radiotherapy and surgery with chemotherapy were 0.84, 0.96, and 0.69. Meanwhile, in SEER database, there are 291 metastatic and 437 localized patients with cAS. The localized patients receiving surgery showed a significantly worse overall survival result when compared with the surgery combined with RT: hazard ratio: 1.6, 95% confidential interval: 1.05, 2.42, P = 0.03.
In conclusion, our study provided a detailed picture of the effectiveness of present treatments for localized and metastatic cAS patients. The CT could be inappropriate in localized patients. For metastatic patients, the surgery combined RT was recommended compared with surgery alone since its enhanced OS prognosis. Yet, more novel-designed clinical trials with specific targeted populations and rigorous conducting are needed for a solid conclusion on which would be a better treatment strategy.
皮肤血管肉瘤（cAS）是一种侵袭性血管肿瘤，起源于血管或淋巴管上皮细胞。由于其罕见性，迄今为止，cAS的文献数量有限，多为单中心经验或报告，最佳治疗策略仍存在争议。本研究旨在进行系统评价，并比较从观察性研究和监测、流行病学及最终结果（SEER）计划中检索到的现有治疗方法的效果。
作者在PubMed、Embase和MEDLINE数据库中进行了系统评价，以确定评估cAS患者治疗的研究。还从SEER计划中获取了被诊断为原发性cAS患者的临床和治疗信息。
32项研究符合条件，但由于信息不明确或不可用，只有其中5项研究（涉及276例患者）被纳入荟萃分析。手术、手术联合放疗和手术联合化疗的5年死亡风险比分别为0.84、0.96和0.69。同时，在SEER数据库中，有291例转移性和437例局限性cAS患者。与手术联合放疗相比，接受手术的局限性患者的总生存结果明显更差：风险比：1.6，95%置信区间：1.05，2.42，P = 0.03。
总之，我们的研究详细描述了目前治疗局限性和转移性cAS患者的有效性。CT在局限性患者中可能不合适。对于转移性患者，与单独手术相比，建议手术联合放疗，因为其可改善总生存预后。然而，需要更多针对特定目标人群且设计新颖、实施严格的临床试验，才能得出哪种治疗策略更好的可靠结论。
