Wait-and-See Policy as a First-Line Management for Extra-Abdominal Desmoid Tumors
Wait-and-See Policy as a First-Line Management for Extra-Abdominal Desmoid Tumors
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DOI：
10.2106/jbjs.m.00988
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发表时间：
2014-04-16
影响因子：
5.3
通讯作者：
Gouin, Francois
中科院分区：
文献类型：
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作者：
Briand, Sylvain;Barbier, Olivier;Gouin, Francois
背景：腹外硬纤维瘤是一种罕见的局部侵袭性肿瘤，无转移潜能。对于它们的最佳管理，目前还没有明确的共识。目前的治疗结果令人失望，腹外硬纤维瘤自发稳定的能力越来越引起人们对保守治疗的兴趣。这项研究的目的是评估观望政策作为腹外硬纤维瘤的一线治疗方法。方法：这项双中心的回顾性研究涉及55名经组织学证实的腹外硬纤维瘤患者。主要结果是退出观望政策的累积概率。观望政策包括对症状的积极管理。结果：最后一次随访时，退出观望政策的累积概率为9.6%。在研究过程中，有47名患者(85%)的肿瘤生长自发停止。一半的肿瘤在一年内稳定下来，超过三年的可能性增加是零星的事件(1例)。再生长2例(4%)。结论：对于原发或复发的腹外硬纤维瘤患者，观望是一种有效的一线治疗方法。这些肿瘤平均在进化一年后会自发稳定下来，观望政策失败的累积概率约为10%。
Background: Extra-abdominal desmoid tumors are rare, locally aggressive neoplasms without metastatic potential. There is no clear consensus regarding their optimal management. The disappointing results of current treatments and the ability of extra-abdominal desmoid tumors to spontaneously stabilize have increasingly drawn interest toward conservative management. The objective of this study was to evaluate a wait-and-see policy as a first-line management for extra-abdominal desmoid tumors.Methods: This two-center retrospective study involved fifty-five patients with a histologically proven extra-abdominal desmoid tumor. The primary outcome was the cumulative probability of dropping out from the wait-and-see policy. The wait-and-see policy included aggressive management of symptoms. We conducted a review of the relevant published series in which a watchful-waiting strategy was used.Results: The cumulative probability of dropping out from the wait-and-see policy was 9.6% at the time of the last follow-up. Spontaneous arrest of tumor growth was noted for forty-seven patients (85%) over the course of the study. Half of the tumors were stabilized at one year, and a potential to increase beyond three years was a sporadic event (one case). Regrowth was found in two patients (4%).Conclusions: A wait-and-see policy is an effective front-line management for patients with primary or recurrent extra-abdominal desmoid tumor. These tumors tend to stabilize spontaneously, on average after one year of evolution, and the cumulative probability of the failure of a wait-and-see policy is approximately 10%.