Prognostic significance of positive surgical margins for scalp angiosarcoma

Chen-Hsiang Kuan; Hung-Wei Yang; Hui-Fu Huang; Lukas Jyuhn-Hsiarn Lee; Tsai-Yu Tseng; Jung-Hsien Hsieh; Nai-Chen Cheng; Hao-Chih Tai; Hong-Shiee Lai

doi:10.1016/j.jfma.2020.04.018

Prognostic significance of positive surgical margins for scalp angiosarcoma

J Formos Med Assoc. 2021 Jan;120(1 Pt 1):217-225. doi: 10.1016/j.jfma.2020.04.018. Epub 2020 May 21.

Authors

Chen-Hsiang Kuan¹, Hung-Wei Yang², Hui-Fu Huang¹, Lukas Jyuhn-Hsiarn Lee³, Tsai-Yu Tseng⁴, Jung-Hsien Hsieh², Nai-Chen Cheng², Hao-Chih Tai², Hong-Shiee Lai⁵

Affiliations

¹ Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
² Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan.
³ National Institute of Environmental Health Sciences, National Health Research Institute, Zhuna, Taiwan; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan; Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan.
⁴ School of Biological Science, University of California, Irvine, United States.
⁵ Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. Electronic address: hslai@ntu.edu.tw.

PMID: 32446755
DOI: 10.1016/j.jfma.2020.04.018

Abstract

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.

Keywords: Angiosarcoma; Prognostic factors; Scalp; Surgery; Surgical margins.

MeSH terms

Hemangiosarcoma* / surgery
Humans
Margins of Excision*
Neoplasm Recurrence, Local
Prognosis
Retrospective Studies
Scalp