Background <p>Angiosarcoma is a rare, aggressive soft tissue sarcoma characterized by poor prognosis and limited treatment consensus. Our aim was to clarify the clinicopathological features, treatment outcomes, and prognostic factors of these patients to inform improved management and follow-up strategies.</p> Methods <p>We retrospectively analyzed the clinical, pathological, treatment, and survival data of patients with angiosarcoma treated from 2003 to 2024 at Zhejiang Cancer Hospital.</p> Results <p>A total of 128 angiosarcoma patients were included, categorized as cutaneous (<i>n</i> = 49), visceral (<i>n</i> = 35), deep soft tissue (<i>n</i> = 31), breast (<i>n</i> = 10), and bone (<i>n</i> = 3). The median progression-free survival (PFS) and overall survival (OS) were 7 and 20&#xa0;months, respectively, with 2-year PFS of 21.4% and 5-year OS of 29.6%. Superficial cases had better outcomes compared to deep-seated cases, larger tumors (&gt; 5&#xa0;cm) and distant metastases predicted worse prognosis. Primary surgery improved survival in localized disease, with adjuvant radiotherapy enhancing local control but not OS. In metastatic cases, first-line systemic therapies showed that paclitaxel-based regimens were less effective than doxorubicin-based chemotherapy, and the addition of anti-angiogenic therapy did not improve outcomes.</p> Conclusion <p>This study underscores the heterogeneity of angiosarcoma across different sites, emphasizing the role of surgery for localized AS, and chemotherapy remains the mainstay for advanced cases. Targeted therapies and immunotherapies offer novel promise, especially the combination strategies.</p>