| Summary: | 碩士 === 國立成功大學 === 環境醫學研究所 === 101 === Background: Hepatic angiosarcoma (HAS) is a rare type of liver cancer that is often fatal. A review of the literature more than three decades ago found that only 3% of patients survived for more than 2 years. Arsenic and vinyl chloride monomer (VCM) are two major causal agents. Although Taiwan is an endemic area for liver cancer, epidemiological data on HAS are limited. With the advancement of medical care, the survival may have been improved. Therefore, we conducted a study to review the cases observed at a teaching hospital to evaluate the roles of VCM, arsenic and viral hepatitis in the occurrence of HAS and to identify treatment modalities that may lead to long term survival.
Materials and Methods: The medical records from January 2000 to August 2010 were reviewed for patients older than 20 years who had pathological proof of HAS. The records were from a teaching hospital which is adjacent to the major VCM processing area in Taiwan and near an endemic area of arsenic exposure from drinking water. We conducted the study with two aims: (1) To evaluate the associations between environmental carcinogens, including VCM, arsenic and viral hepatitis and the occurrence of HAS in this area. (2) To evaluate the predictive factors for long term survival of HAS patients. In addition to cases identified in the study area, we conducted a review of the literature on HAS and included the data in our further analyses. Furthermore, we compared those who survived for 2 years or more with those who did not and summarized their clinical characteristics and treatment modality.
Results: In study (1), six male and three female cases aged from 56 to 83 years (64.6±8.2 years) were identified at the hospital. The differences in clinical features between men and women were not statistically significant. None of them had exposure to VCM or arsenic in drinking water. Two had evidence of hepatitis C infection, but none had evidence of hepatitis B infection. Five male and four female cases aged 30 to 82 years (58.6±15.5 years) were identified in the literature, including two with arsenic exposure and one with chronic hepatitis B infection. In study (2), among the 3,503 patients with primary liver cancer who visited the hospital during the study period, 9 had HAS and 3 (33.3%) of them survived for 2 years or more. One survived for 24 months without surgical resection, the other two received surgery with postoperative chemotherapy and were still alive 32 and 37 months after the onset respectively. Through the review of the literature, we identified three more patients in Taiwan who had survived for two years or more. One survived for 42 months without surgical resection, the other two received segmentectomy with postoperative chemotherapy or radiotherapy and were still alive 24 and 40 months after the onset respectively. We also identified eight such cases outside Taiwan, including one who received chemotherapy without surgery and survived for 53 months. None of the differences in the characteristics between those who had and had not survived for 2 years or more reached statistical significance.
Conclusion: HAS is rare in Taiwan. We found no evidence supporting a major role of environmental toxin or carcinogen such as VCM, arsenic in drinking water, or viral hepatitis in its occurrence. The survival of HAS patients has improved greatly. A combination of surgery and adjuvant chemotherapy may achieve long term survival in a substantial proportion of patients with HAS. Nonetheless, chemotherapy alone, such as hepatic arterial infusion chemotherapy, may still lead to a limited but favorable survival in cases having multinodular tumors with metastasis.
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