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Angiosarcoma of the Thorax: Survival and Risk Factors from the National Cancer Database
Benjamin R. Zambetti, Leah E. Hendrick, William G. Murphy, H Edward Garrett, Jr, Paxton V. Dickson, David Shibata, Stephen W. Behrman, Jeremiah L. Deneve.
University of Tennessee Health Science Center, Memphis, TN, USA.

Background: Angiosarcomas are rare vascular and lymphatic tumors that infrequently arise within the thoracic cavity. We examine the clinicopathologic features, treatment and outcomes among patients with thoracic angiosarcoma.
Methods: The 2004-2015 National Cancer Database (NCDB) was queried for patients with primary thoracic angiosarcoma using ICD-O-3 histology code 9120. Trends in treatment and outcomes for thoracic angiosarcoma were examined. Factors affecting overall survival (OS) were assessed by log rank analysis and Cox proportional hazard regression.
Results: Thoracic angiosarcoma was identified in 253 patients [median age 61 years, male (61%), Charlson comorbidity index 0 (64%)]. Tumors originated in the lung or bronchus (71.5%) or mediastinum (28.5%). Cardiac and esophageal tumors were excluded. The tumor size was < 5 cm in 33%; 40% were grade 3 or 4. Treatment modalities included surgery (n=72, 29%), radiation (n=16, 16%) and systemic chemotherapy (n=116, 47%). The median survival was 4.8 months (95% CI 3.9-6.6). By univariate analysis, age (p=0.03), public insurance (p=0.02), no insurance (p=0.001), higher comorbidity (p=0.02), tumor size >5cm (p-0.05) were associated with a worse survival while surgery (p<0.001) and systemic chemotherapy (p=0.02) were associated with improved OS. By multivariate analysis, public insurance, no insurance, and higher comorbidity were associated with a worse outcome while only surgical resection was associated with a survival benefit (HR 0.5, 95% CI 0.36-0.68, p<0.001).
Conclusions: Thoracic angiosarcoma are rare tumors with a poor outcome. Increasing tumor size, higher comorbidity, and lack of private insurance are associated with a worse outcome. Surgical resection alone provided a survival benefit.


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