Purpose: Angiosarcoma (AS) is a rare, highly aggressive malignant tumor of the vascular endothelium, constituting only 1-2% of all soft tissue sarcomas. It predominantly manifests as cutaneous AS, with the head and neck (HN) region being the most frequently affected site. AS has a high rate of recurrence and metastasis, with overall survival ranging from 6 to 16 months. Given its infrequency, there is also a lack of consensus regarding the factors influencing a worse prognosis and the potential effects of different treatments on prognosis and disease progression. This study aims to gain insight into the factors contributing to the observed differences in tumor spread patterns and overall survival (OS) among different racial groups and explore racial disparities in head and neck AS.
Methods: We conducted a retrospective analysis of HN AS patients treated at Cleveland Clinic from 1997 to 2017. We extracted patient, tumor, and treatment data from the electronic medical record and used a Cox proportional hazards model to identify factors affecting OS among racial groups.
Results: 46 patients were diagnosed with cutaneous HN AS during the study period. Most cases (95.5%) involved the face or scalp—patients presented at a median age of 78 and with a median tumor size of 4.05 cm. Significant differences were observed between White (n=15) and Black (n=19) patients. Although recurrence rates were comparable between groups, Black patients experienced recurrences at a rate twice as fast (810 days vs 451 days, p = 0.0381), primarily at the local level. Conversely, White patients faced regional and distant recurrences. Notably, Black patients had worse overall survival (42.1% vs 20%, p = 0.0002).
Conclusion: Our study highlights racial disparities in head and neck cutaneous angiosarcoma, revealing differences in recurrence patterns and overall survival between White and Black patients. These findings suggest the possibility of a more aggressive subtype among the Black population, necessitating customized treatment approaches. Comprehensive investigations into the genetic factors and underlying mechanisms are required to clarify the root cause of this disparity.