P1953 - Improved Survival Rates in Large Intestinal Angiosarcomas With Spindle-Shaped Cell Morphology and Surgical Intervention: A Systematic Review and Survival Analysis

Shafi Rehman, MD, M.Phil (Scholar)¹, Kaiser O'Sahil. Sadiq, MBBS², Safdar Mohamed, MD³, Anchal Singhal, MBBS⁴, Farhan Thindikkal. Moideen Marsok, MBBS⁵, Pravallika Venna, MBBS⁶, Muhammad Arsalan Bashir, MBBS⁷, Linh Huynh, ⁸, Muhammad Rizwan, ⁹, Himanshi Gupta, MBBS¹⁰, Ameer M. Farrukh, MBBCh^11
1Khyber Medical University, Peshawar, North-West Frontier, Pakistan; ²Plexus Neuro and Stem Cell Research Centre, Bangalore, Karnataka, India; ³Nicolae Testemițanu State University of Medicine and Pharmacy, Chișinău, Chisinau, Moldova; ⁴Lady Hardinge Medical College, Surrey, BC, Canada; ⁵Tamil Nadu Dr. M.G.R. Medical University, Thrissur, Kerala, India; ⁶SVS Medical College, Hyderabad, Telangana, India; ⁷Ziauddin University, Karachi, Sindh, Pakistan; ⁸Kansas College of Osteopathic Medicine, Wichita, KS; ⁹Sheikh Zayed Medical College, Khanpur, Punjab, Pakistan; ¹⁰Lady Hardinge Medical College, New Delhi, Delhi, India; ¹¹University of Galway, Watervliet, NY

Introduction: Angiosarcoma is a rare malignancy arising from vascular or lymphatic endothelial cells that accounts for 1-2% of all soft tissue sarcomas. It most commonly affects the skin and soft tissues. Visceral angiosarcomas may occur in the liver, spleen, adrenals, ovaries, and rarely the gastrointestinal tract.

Methods: A systematic review of PubMed, Science Direct, Embase, and Google Scholar was performed following PRISMA guidelines. These databases were last searched in January 2024. IBM SPSS Statistics Version 26 was used for statistical analysis.

Results: The search strategy yielded 636 references, of which 65 articles were included in our review and analysis, collectively amounting to 69 patients. 53.6% were male and the mean age at presentation was 56.81 ± 21.2 years. 56 (86.1%) were primary malignancies and 9 (13.8%) had metastasized to the large intestine. The median tumor size was 4.0 cm (IQR:1.9-6.0 cm). At presentation, 47/67 (70.1%) reported GI bleeding and 23/65 (35.3%) had abdominal pain. Angiosarcoma was detected in the colon (n=47), rectum (n=17), cecum (n=10), and appendix (n=2). Microscopic examination revealed pleomorphism in 25/54 (46.2 %) and mitotic figures in 23/55 (41.8 %). Cell morphology was spindle-shaped in 14/52 (26.9 %), epithelioid in 39/53 (73.5 %), and mixed in 7/53 (13.2 %). CD 31 was positive in 43/43 (100%), CD 34 in 24/30 (80%), and Factor VIII-related antigen in 22/26 (84.6%) patients. Metastasis was seen in 47/68 (69.1%) patients. Surgical excision was the most common treatment modality, performed in 50/66 (75.7%). 19/66 (28.7%) received chemotherapy and 7/66 (10.6%) received radiotherapy. Patients were followed up for a median of 6.0 months (IQR: 2.3-13.2 months). Mortality was 50%, and survival analysis using Kaplan-Meir curves revealed that patients over the age of 65 years (log-rank test; p=0.03) and histopathological absence of spindle-shaped cells (log-rank test; p= 0.04) were both associated with worse outcomes. Additionally, surgical excision of the tumor was associated with a better prognosis (log-rank, p=0.03).

Discussion: Angiosarcoma of the large intestine is an uncommon entity with relatively high mortality. Gastrointestinal bleeding represents the most common symptom. Cell morphology and age may be useful prognostic markers, with an absence of spindle-shaped cells and age greater than 65 being predictive of a poor prognosis. Surgical resection appears to be superior to chemotherapy and radiotherapy in terms of survival.



Disclosures:


Shafi Rehman, MD, M.Phil (Scholar)¹, Kaiser O'Sahil. Sadiq, MBBS², Safdar Mohamed, MD³, Anchal Singhal, MBBS⁴, Farhan Thindikkal. Moideen Marsok, MBBS⁵, Pravallika Venna, MBBS⁶, Muhammad Arsalan Bashir, MBBS⁷, Linh Huynh, ⁸, Muhammad Rizwan, ⁹, Himanshi Gupta, MBBS¹⁰, Ameer M. Farrukh, MBBCh¹¹. P1953 - Improved Survival Rates in Large Intestinal Angiosarcomas With Spindle-Shaped Cell Morphology and Surgical Intervention: A Systematic Review and Survival Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.