Prognostic Factors Influencing Progression-Free Survival Determined From a Series of Sporadic Desmoid Tumors: A Wait-and-See Policy According to Tumor Presentation
Prognostic Factors Influencing Progression-Free Survival Determined From a Series of Sporadic Desmoid Tumors: A Wait-and-See Policy According to Tumor Presentation
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DOI：
10.1200/jco.2010.33.5489
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发表时间：
2011-09-10
影响因子：
45.3
通讯作者：
Coindre, Jean-Michel
中科院分区：
文献类型：
--
作者：
Salas, Sebastien;Dufresne, Armelle;Coindre, Jean-Michel
目的韧带样肿瘤是一种间叶性成纤维细胞/肌成纤维细胞增生性肿瘤，具有局部侵袭性，早期治疗后易复发。我们公布了迄今为止发表的最大的散发性硬纤维瘤系列研究结果，以确定这些罕见肿瘤的预后因素。患者和方法纳入426例确诊时的硬纤维瘤患者，并对以下参数进行了研究：年龄、性别、首发症状与诊断的延迟时间、肿瘤大小、肿瘤部位、原发癌区域既往手术或创伤史、手术切缘以及妊娠期间或怀孕后不久的育龄妇女腹壁硬纤维瘤的情况。结果在单因素分析中，年龄、肿瘤大小、肿瘤部位和手术切缘(R2与R0/R1)对无进展生存(PFS)有显著影响。对于手术切除质量的显微镜评估，PFS曲线没有显著差异(R0与R1)。在多因素分析中，年龄、肿瘤大小和肿瘤部位是独立变量。根据独立预后不良因素的数量(0或1、2和3)对PFS的预后进行了定义。结论本研究清楚地表明，韧带样瘤有不同的预后亚组，可以受益于不同的治疗策略，包括观望政策。
PurposeDesmoid tumors are mesenchymal fibroblastic/myofibroblastic proliferations with locoregional aggressiveness and high ability to recur after initial treatment. We present the results of the largest series of sporadic desmoid tumors ever published to determine the prognostic factors of these rare tumors.Patients and MethodsFour hundred twenty-six patients with a desmoid tumor at diagnosis were included, and the following parameters were studied: age, sex, delay between first symptoms and diagnosis, tumor size, tumor site, previous history of surgery or trauma in the area of the primary tumor, surgical margins, and context of abdominal wall desmoids in women of child-bearing age during or shortly after pregnancy. We performed univariate and multivariate analysis for progression-free survival (PFS).ResultsIn univariate analysis, age, tumor size, tumor site, and surgical margins (R2 v R0/R1) had a significant impact on PFS. PFS curves were not significantly different for microscopic assessment of surgical resection quality (R0 v R1). In multivariate analysis, age, tumor size, and tumor site had independent values. Three prognostic groups for PFS were defined on the basis of the number of independent unfavorable prognostic factors (0 or 1, 2, and 3).ConclusionThis study clearly demonstrates that there are different prognostic subgroups of desmoid tumors that could benefit from different therapeutic strategies, including a wait-and-see policy.