血管内皮肉瘤75例回顾分析

Retrospective analysis for 75 cases of angiosarcoma

目的探讨血管内皮肉瘤(As)临床以及预后相关因素,寻找对As预后判断有价值的临床指标。方法筛选1994～2005年国内医学期刊公开报道的As共75例;对符合条件者(共43例)纳入分析对象行COX模型分析;根据与预后有关因素:组织学类型、卡氏评分(包括Hb、ESR、是否急症如外伤、出血等)、治疗方式、肿瘤大小、是否转移等5个因素评分分为高危组、中危组、低危组,计算3组1年生存率。结果(1)75例As患者发病部位:脾24例(32.0%),肝13例(17.3%),肺1例(1.3%),乳腺4例(5.3%),消化道4例(5.3%),神经2例(2.7%),脑1例(1.3%),心1例(1.3%),体表及体腔13例(17.3%),肾9例(12.0%),原发部位不明3例(4.0%)。(2)75例患者中:6个月生存率42.7%(32/75),1年生存率33.3%(25/75),3年生存率24.0%(18/75)。(3)3组(43例)1年生存率:高危组25.0%(2/8)、中危组50.0%(7/14)、低危组76.2%(16/21)。结论国内As发病与国外相比,内脏发病率近年呈增加趋势,以脾为最多;根据预后因素制定的预后判断指标可能有助于临床预后的评估。

Objective To investigate the clinical and prognostic factors of angiosarcoma（As）. Methods The clinical data of 75 cases of As were collected in domestic medical magazines from 1994 to 2005, in which 43 cases were analyzed by multivariate COX＇ S. The 43 patients were divided into high-risk group, medium-risk group and lowrisk group according to the risk factors related with prognosis, historical types, Kar＇s scoring including Hb, ESR, trauma and hemorrhage, treatment methods, tumor size. Survival rate of one year was culculated for three groups. Results （1） The primary sites of tumors in 75 patients were as follows： spleen （24 cases, 32.0% ）, liver （13 cases, 17.3 % ）, lung （ 1 cases, 1.3 % ）, breast （4 cases, 5.3 % ）, digestive tract （4 cases, 5.3 % ）, nerve （2 cases, 2.7 % ）, brain （1 case, 1.3%）, heart （ 1 case, 1.3%） and neck and extremities （ 13 cases, 17.3%）, kidney （9 cases, 12.0% ） and unknowned primary site （3 cases, 4.0% ）. （2） Among 75 patients, the survival rates of 6 months, one year and 3 years were 42.7%（32/75） ,33.3% （25/75） ,24.0% （18/75） respectively. （3）The survival rates of one year in three groups （ n = 43） were 25.0% （2/8） in high-risk group, 50.0% （7/14） in medium-risk group, 76.2% （16/21） in low-risk group respectively. Conclusion As compared with that in abroad, the incidence of internal organ （most in spleen） is increased in China. Prognostic indicator formulated according to prognostic factors might be helpful to evaluate the prognosis of As.