Background

Scalp angiosarcomas (AS) are aggressive soft tissue sarcomas that present with outcomes different from other AS of the head and neck region. Due to the rarity of the disease, limited data on the clinical outcome of scalp AS are available. In particular, the prognostic significance of surgical margins remains controversial and the impact of margin status on survival has not been documented.

Methods

We retrospectively reviewed 41 scalp AS patients, including 30 patients with localized disease and 11 patients with initial distant metastasis, treated in our institution between 1997 and 2017. Survival was determined by Kaplan–Meier analysis. In the 30 patients without distant metastasis (localized disease), univariate and multivariate analysis using the Cox proportional hazards model were used to determine clinicopathologic characteristics associated with recurrence free survival (RFS), locoregional control (LRC), and overall survival (OS).

Results

Totally 41 patients diagnosed with scalp AS were identified, including 30 patients with localized disease and 11 patients with initial distant metastasis on diagnosis. Overall, the median follow-up period was 19.3 (range 0.3–128.5) months. The median survival time was 16.6 (range 0.3–144.3) months and the 5-year OS (95% Confidence Interval (CI)) rate was 22% (12%–42%). In the 30 patients with localized disease, univariate analysis showed that positive margins, either lateral-side or deep-side, were significant prognostic factors for RFS, LRC, and OS (p < 0.05). On multivariate analysis, positive margins emerged as adverse prognostic factors for RFS (Hazard Ratio (HR) 4.29, 95% CI, 1.71–10.75, p = 0.002), LRC (HR 6.35, 95% CI, 2.19–18.37, p = 0.001), and OS (HR 4.73, 95% CI, 1.71–13.07, p = 0.003).

Conclusion

Scalp AS is associated with high local recurrence rates and poor survival outcomes. Positive surgical margins are adverse prognostic factors for survival.

中文翻译：

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手术切缘阳性对头皮血管肉瘤的预后意义。

背景

头皮血管肉瘤（AS）是侵袭性软组织肉瘤，其结果与头颈部其他AS不同。由于该疾病的罕见性，关于头皮AS的临床结果的数据有限。尤其是，手术切缘的预后意义仍然存在争议，切缘状态对生存的影响尚未得到证实。

方法

我们回顾性回顾了1997年至2017年间在我院接受治疗的41例头皮AS患者，包括30例局部疾病患者和11例初发远处转移患者。生存率通过Kaplan-Meier分析确定。在30例无远处转移（局部疾病）的患者中，使用Cox比例风险模型进行单因素和多因素分析来确定与无复发生存期（RFS），局部区域控制（LRC）和总生存期（OS）相关的临床病理特征。

结果

共鉴定出41例确诊为头皮AS的患者，包括30例局部疾病患者和11例初步诊断为远处转移的患者。总体而言，中位随访期为19.3个月（范围0.3-128.5）个月。中位生存时间为16.6个月（范围0.3–144.3），5年OS（95％置信区间（CI））率为22％（12％–42％）。在30例局部疾病患者中，单因素分析显示，无论是侧面还是侧面的阳性切缘都是RFS，LRC和OS的重要预后因素（p <0.05）。在多变量分析中，出现阳性切缘是RFS（危险比（HR）4.29，95％CI，1.71-10.75，p = 0.002），LRC（HR 6.35，95％CI，2.19-18.37，p = 0.001）的不良预后因素）和OS（HR 4.73，95％CI，1.71-13.07，p = 0.003）。

结论

头皮AS与局部复发率高和生存结果差有关。手术切缘阳性是生存的不良预后因素。