Surveillance for Angiosarcoma of the Liver Among Vinyl Chloride Workers

Collins, James J.; Jammer, Brenda; Sladeczek, Frank M.; Bodnar, Catherine M.; Salomon, Sergio S.

doi:10.1097/jom.0000000000000247

Cited by 11 publications

(15 citation statements)

References 20 publications

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“…Collins et al reported 15 cases of ASL in the most recent update of the Dow chemical company diseases registry for ASL [ 65 ]. Thirteen ASL cases were at a single plant with high VCM exposure before 1974, which could indicate that exposures were higher at this location than the other locations.…”

Section: Resultsmentioning

confidence: 99%

Association between occupational exposures and sarcoma incidence and mortality: systematic review and meta-analysis

et al. 2021

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Background Sarcomas are a rare and heterogeneous group of tumors originating from mesenchymal or connective tissue. They represent less than 1% of all adult cancers. The etiology and epidemiology of sarcomas remain understudied and poorly understood. The main objective of our study was to systematically assess the association between various occupational exposures and risk of sarcomas. Methods We performed a systematic literature search using the PubMed, Scopus, EMBASE and Cochrane databases to identify relevant cohort and case–control studies. A meta-analysis method was applied on the incidence and mortality outcomes where the estimate with 95% confidence interval (CI) was obtained. Results We included a total of 50 publications in our systematic review and 35 in meta-analysis. For exposures to phenoxy herbicides and chlorophenols, the pooled odds ratio (OR) for sarcoma was 1.85 (95% CI: 1.22, 2.82), based on 16 studies with 2254 participants, while the pooled standardized mortality ratio was 40.93 (95% CI 2.19, 765.90), based on 4 cohort studies with 59,289 participants. For exposure to vinyl chloride monomers the pooled risk ratios for angiosarcoma of the liver and other STS were 19.23 (95% CI 2.03, 182.46) and 2.23 (95 CI 1.55, 3.22) respectively based on 3 cohort studies with 12,816 participants. Exposure to dioxins was associated with an increased STS mortality; the pooled standardized mortality ratio was 2.56 (95% CI 1.60, 4.10) based on 4 cohort studies with 30,797 participants. Finally, woodworking occupation was associated with an increased risk of STS with the pooled OR of 2.16 (95% CI 1.39, 3.36). Conclusions Our findings suggest a positive association between higher exposure to dioxins and increased mortality from STS, between cumulative exposure to vinyl chloride monomers and increased mortality from angiosarcoma of the liver and STS, and between woodworking occupation and STS incidence. These findings were all statistically significant.

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Section: Resultsmentioning

confidence: 99%

Association between occupational exposures and sarcoma incidence and mortality: systematic review and meta-analysis

et al. 2021

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“…Tumor development proved to be associated with numerous environmental carcinogens, such as iatrogenic exposure to the radiocontrast agent Thorotrast (colloidal thorium dioxide), industrial exposure to vinyl chloride monomers, chronic exposure to arsenical compounds and exposure to pesticides, external radiation, and radium. Additionally, cyclophosphamide, urethane, diethylstilbestrol, the use of oral contraceptives, phenylhydrazine, iron, androgenic or anabolic steroids proved to be risk factors associated with HAS development[36,37].…”

Section: Hepatic Angiosarcomasmentioning

confidence: 99%

Malignant hepatic vascular tumors in adults: Characteristics, diagnostic difficulties and current management

Lazăr¹,

Avram²,

Romoşan³

et al. 2019

WJCO

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Malignant vascular tumors of the liver include rare primary hepatic mesenchymal tumors developed in the background of a normal liver parenchyma. Most of them are detected incidentally by the increased use of performing imaging techniques. Their diagnosis is challenging, involving clinical and imaging criteria, with final confirmation by histology and immunohistochemistry. Surgery represents the mainstay of treatment. Liver transplantation (LT) has improved substantially the prognosis of hepatic epithelioid hemangioendothelioma (HEHE), with 5-year patient survival rates of up to 81%, based on the European Liver Intestine Transplantation Association-European Liver Transplant Registry study. Unfortunately, the results of surgery and LT are dismal in cases of hepatic angiosarcoma (HAS). Due to the disappointing results of very short survival periods of approximately 6-7 mo after LT, because of tumor recurrence and rapid progression of the disease, HAS is considered an absolute contraindication to LT. Recurrences after surgical resection are high in cases of HEHE and invariably present in cases of HAS. The discovery of reliable prognostic markers and the elaboration of prognostic scores following LT are needed to provide the best therapeutic choice for each patient. Studies on a few patients have demonstrated the stabilization of the disease in a proportion of patients with hepatic vascular tumors using novel targeted antiangiogenic agents, cytokines or immunotherapy. These new approaches, alone or in combination with other therapeutic modalities, such as surgery and classical chemotherapy, need further investigation to assess their role in prolonging patient survival. Personalized therapeutic algorithms according to the histopathological features, behavior, molecular biology and genetics of the tumors should be elaborated in the near future for the management of patients diagnosed with primary malignant vascular tumors of the liver.

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“…Four findings are helpful to make the differential diagnosis with HHS: (I) HHS is more frequent in men; (II) may be due, in up to 25% of patients, to environmental, toxic factors such as vinyl chloride, cyclophosphamide, thorium dioxide (Thorotrast) and arsenic; (III) HHS is more aggressive, as shown by the more frequently compromised liver function (lower albumin, elevated INR, anaemia and thrombocytopenia) and (IV) at histological level, by the loss of the typical hepatic lobular and portal landmarks (11,13,32,38). It is known that the delay between toxic exposure and HHS development may be extremely long (35 to 65 years) (39,40).…”

Section: Hehementioning

confidence: 99%

“…It is rarely seen in children (42,(61)(62)(63). HHS received much attention due to the association with many environmental carcinogens (Thorotrast, vinyl chloride monomer, radium, pesticides, external radiation, cyclophosphamide, arsenical compounds, use of androgenic/anabolic steroids and iron) (9,23,39,40). Most cases are sporadic.…”

Section: Hhsmentioning

confidence: 99%

Vascular tumours of the liver: a particular story

Lerut

Iesari

2018

Transl. Gastroenterol. Hepatol

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Vascular tumours of the liver represent an underrated chapter of medical and surgical hepatology. These tumours cover a wide spectrum ranging from the frequent and most benign hepatic haemangioma (HH), via the rare and intermediately aggressive hepatic epithelioid haemangioendothelioma (HEHE) to the rare and most malignant hepatic haemangiosarcoma (HHS). In contrast to the treatment algorithms for hepatocellular and cholangiocellular cancer, the diagnostic and therapeutic approaches to HEHE and HHS are not well developed. The related uncertainty is explained by their rare occurrence and their protean clinical, morphological (imaging) and histopathological presentation and behaviour. This article gives an update about these particular tumours based on the analysis of the recent literature and of the studies on vascular tumours published by the European Liver Intestine Transplantation Association (ELITA)-European Liver Transplant Registry (ELTR). It focuses also on the place of liver transplantation (LT) in the respective therapeutic algorithms. The differential diagnosis between these vascular and other tumour types may be very difficult. Correct diagnosis is of utmost importance and is based on a high index of clinical suspicion and on the integration of clinical, radiological, histological [including immunohistochemistry (IHC) and molecular biology findings]. Surgery, be it partial or total hepatectomy (LT), should be proposed whenever possible, because it is the therapeutic mainstay. In HEHE, LT provides excellent results, with long-term diseasefree survivals (DFS) reaching 75%. Good results can be obtained even in case of (frequent) extrahepatic spread. Based on the extensive ELITA-ELTR study a HEHE-LT prognostic score has been proposed in order to estimate the risk of recurrence after LT. In contrast, results of surgery and LT are extremely poor for HHS, for the almost invariably rapid recurrence (within 6 months) and related death within 2 years. LT remains a contraindication for HHS. Due to the still important recurrence rate after surgical resection (25% in HEHE and almost 100% in HHS), there is an urgent need to develop pharmacological treatments targeting angiogenic and non-VEGF angiogenic pathways. To date, some prospective pilot studies and case reports have shown some short-term stabilisation of the disease in small groups of patients. In order to make progress, combination of surgery, anti-angiogenic and immunotherapy seems worthwhile. To complete the panel of vascular liver tumours, infantile haemangioendothelioma, haemangiopericytoma, nodular regenerative hyperplasia (NRH) and hepatic small vessel neoplasms (HSVN) are also discussed.

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Surveillance for Angiosarcoma of the Liver Among Vinyl Chloride Workers

Abstract: We may have seen the last case of ASL among workers exposed to vinyl chloride. Nevertheless, given the long latency of this cancer, continued surveillance seems prudent.

Cited by 11 publications

References 20 publications

Association between occupational exposures and sarcoma incidence and mortality: systematic review and meta-analysis

Association between occupational exposures and sarcoma incidence and mortality: systematic review and meta-analysis

Malignant hepatic vascular tumors in adults: Characteristics, diagnostic difficulties and current management

Vascular tumours of the liver: a particular story

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