Division of Melanoma, Sarcomas and Rare Tumors, European Institute of Oncology, Milan, Italy.
Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy.
Eur J Cancer. 2022 Aug;171:183-192. doi: 10.1016/j.ejca.2022.04.030. Epub 2022 Jun 18.
We retrospectively investigated the role of (neo)adjuvant chemotherapy in patients with primary, localized angiosarcoma.
We selected all patients with primary, localized angiosarcoma, who had received radical surgery between January 2005 and December 2019 at 33 European sarcoma reference centers. The primary objective was to compare the outcome of patients who received (neo)adjuvant chemotherapy versus those who did not, in terms of overall survival (OS), disease-free survival (DFS) and distant metastasis-free survival (DMFS). To reduce the risk of confounding due to imbalance, a propensity-score matching(PSM) was performed. Finally, subgroups analysis was performed according to tumor site, tumor size (< 50 mm or ≥ 50 mm) and patients predicted 10-years OS according to the nomogram sarculator (two different cutoff-values were applied: ≤ 33% or > 33% and < 60% or ≥ 60%).
362 patients were analyzed: 149 (41.2%; treated group) received (neo) adjuvant chemotherapy and 213 (58.6%; control group) did not. The median follow-up for the OS endpoint was 5.1 years (95% CI: 4.0-5.5). The OS-HR was 0.58 (95%CI: 0.40-0.83; p-value = 0.003) in the univariate analysis and 0.74 (95% CI: 0.38-1.43; p = 0.367) in the PSM analysis. The DFS-HR was 0.75 (95% CI: 0.57-0.98; p-value = 0.036) in the univariate analysis, and 0.91 (95% CI:0.56-1.48; p-value = 0.7) in the PSM analysis. The DMFS-HR was 0.75 (95% CI: 0.55-1.02; p-value = 0.065) in univariate analysis and 0.92 (95% CI: 0.53-1.61; p-value = 0.769) in the PSM analysis. Subgroup analysis revealed no heterogeneity of results in strata of tumor site. On the contrary, there was a trend for heterogeneity according to tumor size and patient's risk of death. For all the endpoints analyzed, patients with tumors smaller than 50 mm or at lower risk of death seem to have no benefit from chemotherapy, while patients with larger tumors or at higher risk of death at 10 years seem to derive substantial benefit.
This large, retrospective study suggests that patients affected by > 50 mm and/or high-risk primary, localized angiosarcoma could benefit from (neo)adjuvant chemotherapy.
我们回顾性研究了（新）辅助化疗在原发性局限性血管肉瘤患者中的作用。
我们选择了 2005 年 1 月至 2019 年 12 月期间在 33 个欧洲肉瘤参考中心接受根治性手术的所有原发性局限性血管肉瘤患者。主要目的是比较接受（新）辅助化疗和未接受化疗的患者的总生存（OS）、无病生存（DFS）和远处无转移生存（DMFS）。为了降低因不平衡导致的混杂风险，进行了倾向评分匹配（PSM）。最后，根据肿瘤部位、肿瘤大小（<50mm 或≥50mm）和根据 nomogram sarculator 预测的 10 年 OS 对患者进行亚组分析（应用了两个不同的截止值：≤33%或>33%和<60%或≥60%）。
分析了 362 例患者：149 例（41.2%；治疗组）接受（新）辅助化疗，213 例（58.8%；对照组）未接受化疗。OS 终点的中位随访时间为 5.1 年（95%CI：4.0-5.5）。单因素分析中 OS-HR 为 0.58（95%CI：0.40-0.83；p 值=0.003），PSM 分析中为 0.74（95%CI：0.38-1.43；p=0.367）。单因素分析中 DFS-HR 为 0.75（95%CI：0.57-0.98；p 值=0.036），PSM 分析中为 0.91（95%CI：0.56-1.48；p 值=0.7）。DMFS-HR 在单因素分析中为 0.75（95%CI：0.55-1.02；p 值=0.065），在 PSM 分析中为 0.92（95%CI：0.53-1.61；p 值=0.769）。亚组分析显示，肿瘤部位分层结果无异质性。相反，根据肿瘤大小和患者的死亡风险，存在趋势异质性。对于所有分析的终点，肿瘤小于 50mm 或死亡风险较低的患者似乎不能从化疗中获益，而肿瘤较大或 10 年死亡风险较高的患者似乎从中获益匪浅。
这项大型回顾性研究表明，直径大于 50mm 和/或高风险的原发性局限性血管肉瘤患者可能受益于（新）辅助化疗。
