Tumor Biology Impacts Survival in Surgically Managed Primary Hepatic Vascular Malignancies
Section snippets
Materials and Methods
After approval of the study protocol by the Institutional Review Board (IRB), we performed a retrospective analysis of the 2004-2013 NCDB liver Participant User File (PUF). The International Classification of Diseases (ICD) for Oncology, third edition histology codes 9120 (angiosarcoma), 9130 (hemangioendothelioma), 9133 (epithelioid hemangioendothelioma) and 9150 (hemangiopericytoma) were combined with the liver site code C22.0 to identify patients with primary hepatic vascular malignancies.
Results
One hunderd thirty-seven thousand fifty-one liver neoplasms were captured in the NCDB between 2004 and 2013, with primary hepatic vascular malignancies accounting for 610 (0.5%) of all liver tumors. Amongst them, angiosarcoma was the most common 390 (64%), followed by hemangioendothelioma 216 (35%), and hemangiopericytoma 4 (<1%). The annual rate of new cases did not differ across the study years, averaging 61 new diagnoses of primary hepatic vascular malignancies per year (Table 1).
Discussion
Primary hepatic vascular malignancies are a diverse group of uncommon neoplasms for which surgery, in the form of liver resection or transplantation, is considered the mainstay of curative-intent treatment.5 However, our knowledge of the clinicopathologic factors impacting long-term prognosis following surgical management is limited, potentially resulting in the offering of surgery to patients who may not derive the most benefit from liver resection. In this national cohort of patients with
Conclusions
In this national cohort of primary hepatic vascular malignancies, we discovered that a minority of patients with localized disease receive surgical treatment, despite evidence that those who receive it had a better prognosis. Amongst the patients who receive surgery, tumor biology, in the form of angiosarcoma histology, tumor differentiation and tumor size was strongly associated with worse survival. Additionally, residual tumor burden after resection, in the form of positive surgical margins
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Disclosure: None.
Acknowledgment: Disclosure of funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors contributions: Design of the work: Dogeas and Augustine. Acquisition of data: Dogeas, Mokdad, Augustine. Interpretation of data: Dogeas, Mokdad, Porembka, Polanco, Mansour, Choti, Augustine. Drafting the work: Dogeas, Mokdad, Bhattatiry, Augustine. Final approval: Dogeas, Mokdad, Bhattatiry, Porembka, Polanco, Mansour, Choti, Augustine. Agreement to be accountable for all aspects of the work: Dogeas, Mokdad, Bhattatiry, Porembka, Polanco, Mansour, Choti, Augustine.