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Cutaneous angiosarcoma rates increasing in those older than 70 years

Patient survival in cutaneous angiosarcoma is not affected by current therapeutic strategies, and cases are increasing in those who are older than 70 years, according to researchers in a retrospective analysis.

“In combination with the majority of prior literature, our data demonstrate that there is no optimal therapeutic regiment. It is possible that this is due to the inherent biology of the disease and currently available therapies are not able to modify the natural progression,” Rosalynn R.Z. Conic, MD, PhD, from the department of surgery at University of Maryland, the department of dermatology and plastic surgery at Cleveland Clinic and the department of dermatology at Case Western University, and colleagues wrote.

Cutaneous angiosarcoma (CAS) is rare and may be misdiagnosed as benign atypical lesions, infection, chronic cellulitis, edema or scarring alopecia.

The researchers aimed to update epidemiologic trends and outcomes in CAS using the Surveillance Epidemiology and End Results database. Patients diagnosed with CAS were categorized based on whether they had a previous non-CAS cancer.

Eight hundred eleven individuals had a diagnosis of CAS, of which 346 patients had a prior cancer diagnosis. Those with a prior primary cancer were more likely to be female (P < .001), white (P .001) and diagnosed in the last two decades.

CAS was most common in the trunk in 51% of patients with a prior primary cancer, whereas in 83% of patients without a prior primary cancer, the head and neck were the most common sites. Those without prior cancer also had a larger tumor size (P = .01) and greater extent of disease (P = .048).

Surgery was the most common treatment modality in patients with previous primary cancer (65.3%) and without (39.4%). Combined radiation therapy and surgery was more common in 34% of those without a previous primary cancer compared with 12.7% of patients with a previous primary cancer (P < .001).

The incidence of CAS without a prior primary cancer has steadily increased in the last three decades in patients older than 70 years, according to researchers. The incidence of CAS with a prior primary cancer was highest in the last decade among those aged 70 years and older after adjusting for age, gender and race.

Patients older than 70 years had a higher risk for death than those younger than 50 years (HR 2.16, 95% CI, 1.33-3.57).

The 5-year unadjusted disease specific survival was not statistically different between those who had a prior primary and those who did not, nor did it differ based on treatment modality. The 3-year relative survival rate was 53.7% in those without a prior primary cancer and 56.5% for those with, while 5-year relative survival was 40.3% and 45.8%, respectively, researchers wrote. The worst 5-year survival was identified in patients diagnosed between 1985 and 1994 (65.2%, 95% CI, 56%-75.9%), and those diagnosed between 2005 and 2014 had the best prognosis (82%, 95% CI, 78.4%-85.8%).

The higher rates of patients diagnosed in the last two decades may be due to an increased use of radiation therapy, according to the researchers. – by Abigail Sutton

Disclosures: The authors report no relevant financial disclosures.