Top

Published in:

01-12-2012 | Bone and Soft Tissue Sarcomas

Management and Recurrence Patterns of Desmoids Tumors: A Multi-institutional Analysis of 211 Patients

Authors: Peter D. Peng, MD, Omar Hyder, MD, Michael N. Mavros, MD, Ryan Turley, MD, Ryan Groeschl, MD, Amin Firoozmand, MD, Michael Lidsky, MD, Joseph M. Herman, MD, MSc, Michael Choti, MD, Nita Ahuja, MD, Robert Anders, MD, PhD, Daniel G. Blazer III, MD, T. Clark Gamblin, MD, Timothy M. Pawlik, MD, MPH, PhD

Published in: Annals of Surgical Oncology | Issue 13/2012

Abstract

Background

Desmoid tumors are rare soft-tissue neoplasms with limited data on their management. We sought to determine the rates of recurrence following surgery for desmoid tumors and identify factors predictive of disease-free survival.

Methods

Between January 1983 and December 2011, 211 patients with desmoid tumors were identified from three major surgical centers. Clinicopathologic and treatment characteristics were analyzed to identify predictors of recurrence.

Results

Median age was 36 years; patients were predominantly female (68 %). Desmoid tumors most commonly arose in extremities (32 %), abdominal cavity (23 %) or wall (21 %), and thorax (15 %); median size was 7.5 cm. Most patients had an R0 surgical margin (60 %). The 1- and 5-year recurrence-free survival was 81.3 and 52.8 %, respectively. Factors associated with worse recurrence-free survival were: younger age (for each 5-year increase in age, hazard ratio [HR] = 0.90, 95 % confidence interval [95 % CI] 0.82–0.98) and extra-abdominal tumor location (abdominal wall referent: extra-abdominal site, HR = 3.28, 95 % CI, 1.46–7.36) (both P < 0.05).

Conclusions

Recurrence remains a problem following resection of desmoid tumors with as many as 50 % of patients experiencing a recurrence within 5 years. Factors associated with recurrence included age, tumor location, and margin status. While surgical resection remains central to the management of patients with desmoid tumors, the high rate of recurrence highlights the need for more effective adjuvant therapies.

Latchford AR, Sturt NJ, Neale K, Rogers PA, Phillips RK. A 10-year review of surgery for desmoid disease associated with familial adenomatous polyposis. Br J Surg. 2006;93:1258–64.PubMedCrossRef

Phillips SR, A’Hern R, Thomas JM. Aggressive fibromatosis of the abdominal wall, limbs and limb girdles. Br J Surg. 2004;91:1624–9.PubMedCrossRef

Reitamo JJ, Scheinin TM, Hayry P. The desmoid syndrome. New aspects in the cause, pathogenesis and treatment of the desmoid tumor. Am J Surg. 1986;151:230–7.PubMedCrossRef

Rock MG, Pritchard DJ, Reiman HM, Soule EH, Brewster RC. Extra-abdominal desmoid tumors. J Bone Joint Surg Am. 1984;66:1369–74.PubMed

Müller J. Über den feineren Bau und die Formen der krankhaften Geschwülste. Erste Lieferung. Berlin: G. Reimer; 1838.

Sakorafas GH, Nissotakis C, Peros G. Abdominal desmoid tumors. Surg Oncol. 16:131–42.

Huang K, Fu H, Shi YQ, Zhou Y, Du CY. Prognostic factors for extra-abdominal and abdominal wall desmoids: a 20-year experience at a single institution. J Surg Oncol. 2009;100:563–9.PubMedCrossRef

Lev D, Kotilingam D, Wei C, Ballo MT, Zagars GK, Pisters PW, et al. Optimizing treatment of desmoid tumors. J Clin Oncol. 2007;25:1785–91.PubMedCrossRef

Salas S, Dufresne A, Bui B, Blay JY, Terrier P, Ranchere-Vince D, et al. Prognostic factors influencing progression-free survival determined from a series of sporadic desmoid tumors: a wait-and-see policy according to tumor presentation. J Clin Oncol. 2011;29:3553–8.PubMedCrossRef

10.

Rodriguez-Bigas MA, Mahoney MC, Karakousis CP, Petrelli NJ. Desmoid tumors in patients with familial adenomatous polyposis. Cancer. 1994;74:1270–4.PubMedCrossRef

11.

Kulaylat MN, Karakousis CP, Keaney CM, McCorvey D, Bem J, Ambrus Sr JL. Desmoid tumour: a pleomorphic lesion. Eur J Surg Oncol. 1999;25:487–97.PubMedCrossRef

12.

Ballo MT, Zagars GK, Pollack A, Pisters PW, Pollack RA. Desmoid tumor: prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol. 1999;17:158–67.PubMed

13.

Gronchi A, Casali PG, Mariani L, Lo Vullo S, Colecchia M, Lozza L, et al. Quality of surgery and outcome in extra-abdominal aggressive fibromatosis: a series of patients surgically treated at a single institution. J Clin Oncol. 2003;21:1390–7.PubMedCrossRef

14.

Sprague S, Matta JM, Bhandari M, et al. Multicenter collaboration in observational research: improving generalizability and efficiency. J Bone Joint Surg Am. 2009;91 Suppl 3:80–6.PubMedCrossRef

15.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.PubMedCrossRef

16.

Fiore M, Rimareix F, Mariani L, Domont J, Collini P, Le Péchoux C, et al. Desmoid-type fibromatosis: a front-line conservative approach to select patients for surgical treatment. Ann Surg Oncol. 2009;16:2587–93.PubMedCrossRef

17.

Stoeckle E, Coindre JM, Longy M, Binh MB, Kantor G, Kind M, et al. A critical analysis of treatment strategies in desmoid tumours: a review of a series of 106 cases. Eur J Surg Oncol. 2009;35:129–34.PubMedCrossRef

18.

Lazar AJ, Tuvin D, Hajibashi S, Habeeb S, Bolshakov S, Mayordomo-Aranda E, et al. Specific mutations in the beta-catenin gene (CTNNB1) correlate with local recurrence in sporadic desmoid tumors. Am J Pathol. 2008;173:1518–27.PubMedCrossRef

19.

Sorensen A, Keller J, Nielsen OS, Jensen OM. Treatment of aggressive fibromatosis: a retrospective study of 72 patients followed for 1–27 years. Acta Orthop Scand. 2002;73:213–9.PubMedCrossRef

20.

Bonvalot S, Eldweny H, Haddad V, Rimareix F, Missenard G, Oberlin O, et al. Extra-abdominal primary fibromatosis: aggressive management could be avoided in a subgroup of patients. Eur J Surg Oncol. 2008;34:462–8.PubMedCrossRef

21.

Salas S, Chibon F, Noguchi T, Terrier P, Ranchere-Vince D, Lagarde P, et al. Molecular characterization by array comparative genomic hybridization and DNA sequencing of 194 desmoid tumors. Genes Chromosomes Cancer. 2010;49:560–8.PubMed

22.

Merchant NB, Lewis JJ, Woodruff JM, Leung DH, Brennan MF. Extremity and trunk desmoid tumors: a multifactorial analysis of outcome. Cancer. 1999;86:2045–52.PubMedCrossRef

Title: Management and Recurrence Patterns of Desmoids Tumors: A Multi-institutional Analysis of 211 Patients
Authors: Peter D. Peng, MD
Omar Hyder, MD
Michael N. Mavros, MD
Ryan Turley, MD
Ryan Groeschl, MD
Amin Firoozmand, MD
Michael Lidsky, MD
Joseph M. Herman, MD, MSc
Michael Choti, MD
Nita Ahuja, MD
Robert Anders, MD, PhD
Daniel G. Blazer III, MD
T. Clark Gamblin, MD
Timothy M. Pawlik, MD, MPH, PhD
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Annals of Surgical Oncology / Issue 13/2012
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-012-2634-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Management and Recurrence Patterns of Desmoids Tumors: A Multi-institutional Analysis of 211 Patients

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 13/2012

Analysis and Comparison of the 7th Edition American Joint Committee on Cancer (AJCC) Nodal Staging System for Metastatic Cutaneous Squamous Cell Carcinoma of the Head and Neck

Axillary Recurrence After a Tumor-Positive Sentinel Lymph Node Biopsy Without Axillary Treatment: A Review of the Literature

Fear of Cancer Recurrence after Curative Pancreatectomy: A Cross-sectional Study in Survivors of Pancreatic and Periampullary Tumors

Prognostic Significance of cyclin D1, β-catenin, and MTA1 in Patients with Invasive Ductal Carcinoma of the Breast

Standards of Outcome Reporting in Surgical Oncology: A Case Study in Esophageal Cancer

Surgical Site Infection after Breast Surgery: Impact of 2010 CDC Reporting Guidelines