ABSTRACT
Data on prognostic factors and treatment outcomes for chest wall soft tissue sarcomas (STS) are sparse. Wide resections with negative margins are the mainstay of therapy, but the prognostic impact of surgical margins remains controversial. The purpose of the present study was to determine the significance of microscopic margins through a long-term follow-up. The associations between local recurrence-free survival (LRFS), overall survival (OS) and potential prognostic factors were retrospectively assessed in a consecutive series of 110 patients who were suitable for surgical treatment with curative intent. Potential prognostic factors were assessed using univariate and multivariate analyses. The median follow-up time following primary diagnosis was 9.6 years [95% confidence interval (CI), 7.2-10.5]. In the entire cohort, the 5-year estimates of the OS and LRFS rates were 66.0% (95% CI, 55.9-74.3) and 60.6% (95% CI, 50.3-69.4), respectively. A total of 27 patients (24.5%) developed distant metastases with a median survival time of 0.9 years following the diagnosis of metastasis. Surgical margins attained at the initial resection and eventual re-excisions significantly influenced OS in univariate analysis (5-year OS, R0 69.9% vs. R1/R2 38.5%; P=0.046), but this failed to reach statistical significance in the multivariate analysis. In the multivariate analysis, significant adverse prognostic features of LRFS included angiosarcoma subtype, G2 and G3 histology. For OS, the only independent significant predictors were age >50 years, tumor size >5 cm, angiosarcoma subtype and G3 histology. The results of the present study suggest that tumor biology, as reflected by the histological grade, influences the final outcome in patients with chest wall STS. Surgical margins failed to reach statistical significance in multivariate analysis as they demonstrated a dependency towards the independent predictors of OS. Subsequently, a positive margin status may be a result rather than a cause of biological aggressiveness, and it may not influence the outcome directly.
ABSTRACT
Background Radiation-induced angiosarcomas of the breast are rare secondary malignancies that occur after adjuvant radiation of breast cancer. They grow in a multifocal manner and frequently develop local recurrences. Therefore, they often pose a surgical challenge. Due to their rarity it is still unclear whether a radical surgical approach leads to a beneficial outcome. The aim of this study was to determine the prognostic significance of surgical margins. Patients and methods We retrospectively assessed the outcome of 18 patients who underwent surgical treatment at our institution. The median follow-up was 4.4 years. Univariate analyses were performed to determine the prognostic significance of the assessed factors on local recurrence-free survival (LRFS) and overall survival (OS). Results The median patient age was 66.3 years. The median latency between radiation and angiosarcoma occurrence was 6.9 years. The estimated 5-year rates for LRFS and OS were 25.0% (95% confidence interval [CI]: 7.8-47.2) and 53.8% (95% CI: 26.8-74.8). R0 resection of the primary lesion was associated with a significant improvement in LRFS (p=0.017) and OS (p=0.013). Moreover, R0 resection of the last local recurrence was also associated with a more favourable OS (p=0.040). Conclusions Due to their aggressive growth pattern and pronounced tendency to local recurrence, a radical surgical approach should be sought in the treatment of radiation-induced angiosarcomas. Wherever feasible, surgical treatment should aim at R0 margins in order to improve local control and OS.
Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/surgery , Hemangiosarcoma/diagnosis , Hemangiosarcoma/surgery , Neoplasms, Radiation-Induced/diagnosis , Neoplasms, Radiation-Induced/surgery , Neoplasms, Second Primary/diagnosis , Neoplasms, Second Primary/surgery , Radiotherapy, Adjuvant/adverse effects , Adult , Aged , Aged, 80 and over , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Disease-Free Survival , Female , Hemangiosarcoma/mortality , Hemangiosarcoma/pathology , Humans , Middle Aged , Neoplasm Recurrence, Local/diagnosis , Neoplasm Recurrence, Local/mortality , Neoplasm Recurrence, Local/pathology , Neoplasm Recurrence, Local/surgery , Neoplasm Staging , Neoplasms, Multiple Primary/diagnosis , Neoplasms, Multiple Primary/mortality , Neoplasms, Multiple Primary/pathology , Neoplasms, Multiple Primary/surgery , Neoplasms, Radiation-Induced/mortality , Neoplasms, Radiation-Induced/pathology , Neoplasms, Second Primary/mortality , Neoplasms, Second Primary/pathology , Prognosis , Reoperation , Retrospective StudiesABSTRACT
BACKGROUND: Angiosarcomas are aggressive soft tissue sarcomas. Due to their rarity there is a paucity of data regarding the clinical outcome of patients with non-visceral angiosarcomas of the soft tissues. In particular, the prognostic significance of surgical margins remains controversial. PATIENTS AND METHODS: We retrospectively assessed the outcome of 43 patients with localised disease suitable for surgical treatment with curative intent. The median follow-up was 7.5 years. RESULTS: The 5-year overall survival (OS) rate was 46.2%. Sixteen patients (37.2%) were diagnosed with secondary, radiation-induced angiosarcomas. Twenty-four patients (55.8%) developed local recurrences and 15 patients (34.9%) distant metastases. Negative surgical margin emerged as the only statistically significant prognostic factor (5-year OS: R0 51.8% vs. R1/R2 17.1%, p=0.036). As indicated in the regression analysis, close and wide negative margins within the R0 subgroup led to similar outcomes. CONCLUSION: Angiosarcomas have a high risk of local recurrence and metastasis. Surgical resection with negative margins improves the outcome.
