Angiosarcoma of the Breast Management and Outcomes
Angiosarcoma of the Breast Management and Outcomes
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DOI：
10.1097/coc.0000000000000753
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发表时间：
2020-11-01
影响因子：
2.6
通讯作者：
Horst, Kathleen C.
中科院分区：
文献类型：
--
作者：
Gutkin, Paulina M.;Ganjoo, Kristen N.;Horst, Kathleen C.
目的：乳腺血管肉瘤是一种罕见的肿瘤，预后差。我们回顾了我们机构治疗这种疾病的经验，以描述其表现，确定管理模式，并报告结果。方法：回顾性分析1998年至2019年收治的58例非转移性血管肉瘤患者的临床资料。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）。结果：中位随访时间为43.4个月（范围：1.8至203.3个月）。原发性血管肉瘤（PAS）24例，继发性血管肉瘤（SAS）34例。PAS组患者年龄明显小于SAS组（P0.0001）。乳房切除术是我们队列（n=47）的主要手术治疗，3例接受了乳房肿瘤切除术。PAS组5/23例，SAS组11/35例。28例患者接受化疗。13例PAS和3例SAS患者接受了放射治疗。PAS的5年OS为73.7%，SAS为63.5%。切缘≤ 5 mm的患者局部复发的比例更高。化疗不影响RFS，与PAS中的OS无关（P=0.35）。化疗组SAS患者的OS显著高于未化疗组（P=0.043）。辐射没有显着影响RFS或OS. Conclusions：五年OS高于预期。>5 mm的边缘对于局部控制似乎很重要。SAS患者，而不是PAS患者，化疗可能会提高生存率。可能需要使用预先指定的药物进行国家试验，以确定SAS女性的最佳化疗方案。
Objective: 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. Methods: 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. Results: 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 (P0.0001). 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. 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. Conclusions: 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.