血管肉瘤临床单中心治疗分析

目的 分析血管肉瘤治疗后的生存情况及影响预后的因素。方法 回顾分析1988—2015年间本院收治的经病理证实有完整随访资料的30例血管肉瘤患者资料。综合治疗18例，其中手术+放疗9例、手术+放疗+化疗4例、手术+化疗5例;非综合治疗12例，其中单纯手术11例、单纯放疗1例。Kaplan-Meier法计算生存率并Logrank法检验，Cox模型多因素预后分析。结果 1、2、5年样本量分别为29、26、18例。1、2、5年OS率分别为70.1%、49.1%、40.9%，LRFS率分别为52.8%、44.0%、35.2%，DMFS率分别为81.6%、68.0%、56.7%。单因素分析显示发病部位、肿瘤大小、分期、初次治疗后有无肉眼肿瘤残留与OS相关(P=0.027、0.027、0.011、0.000);Ⅰ、Ⅱ期患者综合治疗较单一治疗者LR率低(P=0.006);性别、年龄、分期、发病部位与DM相关(P=0.028、0.011、0.015、0.022)。结论 血管肉瘤LR和DM率高预后差，应早诊断、早治疗;对Ⅰ、Ⅱ期患者也应进行综合治疗(手术+放疗±化疗)，预后因素包括发病部位、肿瘤大小、分期、初次治疗后有无肉眼肿瘤残留。

Treatment of angiosarcoma at a single institution

Objective To analyze the survival and prognostic factors in the treatment of angiosarcoma. Methods A retrospective study was performed on clinical data of 30 patients pathologically diagnosed with angiosarcoma who were admitted to our hospital from 1988 to 2015 and had complete follow-up data. In those patients, 18 patients received comprehensive treatment, containing 9 patients treated with surgery plus radiotherapy, 4 patients with surgery plus chemoradiotherapy, and 5 with surgery plus chemotherapy;12 patients received non-comprehensive treatment, containing 11 patients treated with surgery alone and 1 patient radiotherapy alone. The survival rates were calculated using the Kaplan-Meier method and analyzed using the log-rank test. The Cox regression model was used for multivariate prognostic analyses. Results The 1-, 2-, and 5-year sample sizes were 29,26, and 18, respectively. The 1-, 2-, and 5-year overall survival (OS) rates were 70.1%, 49.1%, and 40.9%, respectively;the 1-, 2-, and 5-year local relapse-free survival rates were 52.8%, 44.0%, and 35.2%, respectively;the 1-, 2-, and 5-year distant metastasis-free survival rates were 81.6%, 68.0%, and 56.7%, respectively. The multivariate analysis showed that tumor site, tumor size, staging, and visible tumor residue after initial treatment were prognostic factors for OS (P=0.027,0.027,0.011,0.000);In the patients with stage Ⅰ or Ⅱ disease, the comprehensive treatment achieved a significantly lower local-relapse rate than the individual treatment (P=0.006);gender, age, staging, and tumor site were prognostic factors for distant metastasis (P=0.028,0.011,0.015,0.022). Conclusions Early diagnosis and early treatment are recommended for angiosarcoma, which has high local recurrence and distant metastasis rates. Comprehensive treatment (surgery plus radiotherapy and/or chemotherapy) is recommended for patients with stage Ⅰ or Ⅱ disease. Tumor site, tumor size, staging, and visible tumor residue after initial treatment are prognostic factors.