1. Prognosis of angiosarcoma at different anatomic sites
Biing-Luen Lee, MD. Cheng-Feng Chen
Division of Plastic and Reconstructive Surgery,
Department of Surgery,
Taipei Veterans General Hospital.
Koo Foundation Sun Yat-Sen Cancer Center
Taipei, Taiwan

2. Introduction
Angiosarcomas are rare soft-tissue sarcomas of endothelial cell origin that have a poor prognosis
Angiosarcomas are subdivided into cutaneous angiosarcoma, lymphoedema-associated angiosarcoma, radiation-induced angiosarcoma, primary-breast angiosarcoma, and soft-tissue angiosarcoma
-Robin J Young et al. Review: Angiosarcoma. Lancet Oncol 2010; 11: 983–91

3. Treatment
Surgery with wide excision as the main curative treatment option. Local control is improved with adjuvant radiotherapy. There is no compelling evidence for adjuvant chemotherapy
-Robin J Young et al. Lancet Oncol 2010; 11: 983–91

4. Anatomic sites distribution
- Bo-Wen Li et al, J Taiwan Soc of Plast Surg 2010;19:287∼300)
-Robin J Young et al. Lancet Oncol 2010; 11: 983–91

5. -Matthew G. Fury et al, Cancer J 2005:11:241-247

6. Primary site in the liver, presence of metastases and performance status were correlated to poor overall survival, whereas soft tissue primary tumors independently correlated to better survival
- J. Fayette et al, Annals of Oncology 18: 2030–2036, 2007

7. Material and Method Scalp and face Trunk Liver
Retrospective chart review
From 1996 to 2011, pathology reported angiosarcoma from Koo Foundation Sun Yat- Sen Cancer Center and Taipei veteran general hospital
Angiosarcoma at:
Scalp and face
Trunk
Liver

8. Patients with incomplete data, concurrent cancer were excluded
Start time: since symptoms appeared
Operation: tumor wide excision/ metastasectomy, excisional biopsies were not included

9. Results Total 44 patients
24 patients had angiosarcoma at scalp and face
9 at trunk (7 at breast, 1 at lower abdomen and 1 at left supra-scapula region)
11 at liver

10. Patient and tumor characteristics
Scalp and face
Trunk
liver
P value
Sex
<0.0001
Male
20 (83.3%)
0 (0%)
4 (36.4%)
Female
4 (16.7%)
9 (100%)
7 (63.6%)
Age (mean±SD)
76.58±9.353
42.33±7.794
68.36±12.948
Alcohol
5 (20.8%)
1 (11.1%)
2 (18.2%)
0.799
Smoking
8 (33.3%)
1 (9.1%)
0.062
HTN
12 (50%)
5 (45.5%)
0.024 DM
0.246
CAD
2 (8.3%)
1.000
Hepatitis
0.001
Hyperlipidemia
6 (25%)
2 (22.2%)
Hyperuricemia
3 (12.5%)
0.643 TB
0.404

11. Scalp and face
Trunk
liver
P value
Focality
0.002
Solitary
16 (66.7%)
7 (77.8%)
1 (9.1%)
Multifocal
8 (33.3%)
2 (22.2%)
10 (90.9)
Size (mm)
59.25±77.790
82.44±57.267
59.32±60.063
0.278
Operation
19 (79.2%)
8 (88.9%)
<0.0001
Stage operation
9 (37.5%)
6 (66.6%)
0 (0%)
0.003
Radiation
Chemotherapy
12 (50%)
6 (66.7%)
5 (45.5%)
0.665
Distant mets
5 (55.6%)
4 (36.4%)
0.259
Lung mets
4 (44.4%)
2 (18.2%)
0.425
Liver mets
2 (8.3%)
3 (33.3%)
0.185
Bone mets
3 (12.5%)
11 (25%)
0.399
LN mets
7 (29.9%)
2 (18%)
0.212
5-year survival
8.3%
64.8% 0%

12. Overall survival Liver Scalp and face Trunk
Kaplan–Meier method, Log rank P<0.0001

13. Cox regression forward stepwise
Variables HR
95% CI of HR
P value
Lower
Upper
Location (Trunk vs. head)
0.040
0.009
0.190
<0.0001
Location (Liver vs. head)
6.890
2.261
20.998
0.001
Focality (Solitary vs. multifocal)
0.378
0.147
0.970
0.043
Operation
0.060
0.017
0.207
Chemotherapy
0.090
0.030
0.272
Lung mets
4.213
1.650
10.753
0.003
Liver mets
7.271
2.121
24.919
0.002
Variables: age, sex, location, focality, size, op, RT, chemo, dis met, lung met, liver met, bone met, LN mets

14. Cases received operation (Head vs. Trunk)
Scalp and face (n=19)
Trunk (n=8)
P value
Sex
<0.0001
Male
16 (84.2%)
0 (0%)
Female
3 (15.8%)
8 (100%)
Age
76.21±9.537
41.25±7.573
Alcohol
4 (21.1%)
1 (12.5%)
1.000
Smoking
8 (33.3%)
0.055
HTN
11 (57.9%)
0.008 DM
2 (10.5%)
CAD
Hepatitis
Hyperlipidemia
2(25.0%)
Hyperuricemia
2 (25.0%)
0.558 TB

15. Scalp and face (n=19)
Trunk (n=8)
P value
Focality
0.633
Solitary
13 (68.4%)
7 (85.7%)
multifocal
6 (31.6%)
1 (12.5%)
Size (mm)
39.58±36.34
90.25±55.869
0.014
Stage operation
0.529
Once
10 (52.6%)
2 (25%)
More then twice
9 (48.4%)
6 (75%)
Radiation
16 (84.2%)
7 (87.5%)
1.000
Chemotherapy
9 (47.4%)
6 (75.0%)
0.236
Margin status
0.419 R0
13 (72.2%)
8 (100%) R1
2 (11.1%)
0 (0%) R2
3 (16.7%)
Local recurrence
15 (78.9%)
3 (37.5%)
0.398
Distant mets
16 (66.7%)
5 (62.5%)
Lung mets
8 (42.1%)
4 (50.0%)
Liver mets
2 (10.5%)
0.136
Bone mets
3 (15.8%)
0.227
LN mets
Reconstruction
0.002 No
5 (71.4%)
Skin graft
7 (38.9%)
Flap
2 (28.4%)
Flap and graft

16. Overall survival
Scalp and face
Trunk
P=0.014

17. Recurrence-free and metastasis-free survival
P=0.010
P=0.130

18. Results
Scalp and face angiosarcomas are more common in old male patients, more difficult to reach free margin status, more likely to recur locally and metastasize distantly with poor prognosis
Usually needs flaps or grafts for reconstruction

19. Trunk (breast) angiosarcomas are more common in younger women, usually solitary but bigger in size and easier to reach free margin status, with better prognosis and survival
Patients with liver angiosarcomas often had multifocal lesions, less possible to receive operation with the worst prognosis

20. Discussion
Represents clinical presentation and treatment of angiosarcoma cases in Taiwan
All 7 cases of breast angiosarcomas in our series didn’t have radiation exposure history, and are primary-breast angiosarcomas
More primary-breast angiosarcoma cases in Taiwan

21. Breast angiosarcoma cases at Mayo Clinic from 1960 to 2008 were identified
- JEFFREY S. SCOW et al, Journal of Surgical Oncology 2010;101:401–407

22. Limitations Small sample size Incomplete patient information
Lack of pathological data

23. Thank you for your attention!!