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Malignant Vascular Tumors: Clinical Presentation, Surgical Therapy, and Long-Term Prognosis

¹ Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
² Unit for Documentation and Statistics, Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
³ Institute of Pathology, University of Heidelberg, Im Neuenheimer Feld 220/221, 69120 Heidelberg, Germany
⁴ Department of Surgery and Vascular Surgery, Mannheim University Clinic, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68135 Mannheim, Germany
⁵ Department of Vascular and Endovascular Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany

Correspondence: Address correspondence and reprint requests to: Matthias H. M. Schwarzbach, MD, Department of Surgery and Vascular Surgery, Mannheim University Clinic, University of Heidelberg, Theodor-Kutzer Ufer 1-3, 68135 Mannheim, Germany; E-mail: matthias. schwarzbach{at}chir.ma.uni-heidelberg.de.

Background: The aim of this study was to analyze the presentation of, surgery for, and prognosis of malignant vascular tumors (MVTs).

Methods: This was an observational single-center study. Patients who underwent operation for MVTs between 1988 and 2004 were included. Data were gathered prospectively in a computerized registry.

Results: Of 568 adult patients with soft tissue malignancies, 43 (7.6%) were treated for MVTs. Twenty-four men and 19 women (median age, 55.3 years) were referred for 30 primary tumors and 13 recurrences. Symptoms were observed in 90.7% of the cases (swelling [37.2%], pain [34.9%], extrusion [11.6%], hemorrhage [7%], weight loss [4.7%], loss of energy [4.7%], impaired function [4.7%], and others [30.2%]). Tumors were located in the extremities (n = 16), trunk (n = 3), abdomen (n = 15), retroperitoneum (n = 7), and thyroid gland (n = 2). Twenty-two (51.2%) angiosarcomas, nine (20.9%) malignant hemangiopericytomas, eight (18.6%) malignant epithelioid hemangioendotheliomas, and four (9.3%) lymphangiosarcomas were seen. The median overall survival after surgery was 21.4 months, with 2-, 5-, and 10-year overall survival rates of 41.5%, 38.3%, and 18.8%, respectively. MVTs of the extremities and trunk and localized disease indicated a better prognosis than abdominal or retroperitoneal MVTs (univariate and multivariate analyses: P = .0122 and P = .0287) and metastasized stages (univariate and multivariate analyses: P = .0187 and P = .0287).

Conclusions: A considerable number of patients with soft tissue malignancies undergo surgery for MVT. Various symptoms and a multilocular occurrence are typical. The course of MVTs is aggressive. Tumor site and stage are important prognostic factors. Surgery is potentially curative, especially for localized disease of the extremities and trunk.

Key Words: Malignant vascular tumors • Survival • Prognostic factors • Univariate analysis • Multivariate analysis