Primary liver sarcomas in the modern era: Resection or transplantation?

Background and ObjectivesPrimary liver sarcomas (PLS) are rare. Published series are limited by small numbers of patients. MethodsWe reviewed the National Cancer Database (2004-2014) for patients who underwent surgical resection of PLS. ResultsOf 237 patients identified, the majority were female (60.8%), with median age of 52 years. Histologies were: epithelioid hemangioendothelioma (n=67), angiosarcoma (n=64), leiomyosarcoma (n=33), embryonal rhabdomyosarcoma (n=31), carcinosarcoma (n=16), giant cell sarcoma (n=14), spindle cell sarcoma (n=12). Ninety-seven (40.9%) patients underwent lobectomies or extended lobectomies, 41 patients (17.3%) underwent transplantation. Surgical margins were negative in 82.9%. Tumors were well differentiated in 11.3%. Histology type correlated with outcome with the best prognosis for epithelioid hemangioendothelioma (OS: not reached, similar for resection and transplantation) and the worst for angiosarcoma (OS:16.6mo with resection; 6mo with transplantation; P=0.04). Resections with microscopically negative margins were associated with improved survival (58.7 vs 11.3mo for positive margins; P<0.001). Chemotherapy and radiation therapy were used in a minority of patients (32.9% and 4.3% respectively) with no improvement in outcomes. ConclusionsBoth hepatic resection and liver transplantation can be associated with long term survival for selected primary liver sarcomas such as epitheliod hemangioendotheliomas. Histology type and the ability to resect the tumor with negative margins correlate with outcomes and the decision to operate should be carefully weighed for subtypes with particularly dismal prognosis such as angiosarcomas.