Desmoid-type fibromatosis and pregnancy: A multi-institutional analysis of recurrence and obstetric risk

Marco Fiore, Sara Coppola, Amanda J. Cannell, Chiara Colombo, Monica M. Bertagnolli, Suzanne George, Axel Le Cesne, Rebecca A. Gladdy, Paolo G. Casali, Carol J. Swallow, Alessandro Gronchi, Sylvie Bonvalot, Chandrajit P. Raut

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND: Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE: To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS: A cohort of women with DF and pregnancy was identified from 4 sarcoma centers. Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed. RESULTS: Ninety-two women were included. Forty-four women (48%) had pregnancy-related DF (A + B), whereas 48 (52%) had a history of DF before conception (C + D). Initial treatment was resection in 52%, medical therapy in 4%, and watchful waiting in 43%. Postsurgical relapse rate in A + B was 13%, although progression during watchful waiting was 63%. Relapse/progression in C + D was 42%. After pregnancy, 46% underwent treatment of DF, whereas 54% were managed with watchful waiting. Eventually, only 17% experienced further progression after treatment. Spontaneous regression occurred in 14%. After further pregnancies, only 27% progressed. The only related obstetric event was a cesarean delivery. CONCLUSIONS: Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.

Original languageEnglish
Pages (from-to)973-978
Number of pages6
JournalAnnals of Surgery
Volume259
Issue number5
DOIs
Publication statusPublished - 2014

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Aggressive Fibromatosis
Fibroma
Obstetrics
Recurrence
Pregnancy
Watchful Waiting
Therapeutics
Sarcoma

Keywords

  • aggressive fibromatosis
  • desmoid-type fibromatosis
  • pregnancy
  • prognosis
  • wait and see

ASJC Scopus subject areas

  • Surgery

Cite this

Desmoid-type fibromatosis and pregnancy : A multi-institutional analysis of recurrence and obstetric risk. / Fiore, Marco; Coppola, Sara; Cannell, Amanda J.; Colombo, Chiara; Bertagnolli, Monica M.; George, Suzanne; Le Cesne, Axel; Gladdy, Rebecca A.; Casali, Paolo G.; Swallow, Carol J.; Gronchi, Alessandro; Bonvalot, Sylvie; Raut, Chandrajit P.

In: Annals of Surgery, Vol. 259, No. 5, 2014, p. 973-978.

Research output: Contribution to journalArticle

Fiore, M, Coppola, S, Cannell, AJ, Colombo, C, Bertagnolli, MM, George, S, Le Cesne, A, Gladdy, RA, Casali, PG, Swallow, CJ, Gronchi, A, Bonvalot, S & Raut, CP 2014, 'Desmoid-type fibromatosis and pregnancy: A multi-institutional analysis of recurrence and obstetric risk', Annals of Surgery, vol. 259, no. 5, pp. 973-978. https://doi.org/10.1097/SLA.0000000000000224
Fiore, Marco ; Coppola, Sara ; Cannell, Amanda J. ; Colombo, Chiara ; Bertagnolli, Monica M. ; George, Suzanne ; Le Cesne, Axel ; Gladdy, Rebecca A. ; Casali, Paolo G. ; Swallow, Carol J. ; Gronchi, Alessandro ; Bonvalot, Sylvie ; Raut, Chandrajit P. / Desmoid-type fibromatosis and pregnancy : A multi-institutional analysis of recurrence and obstetric risk. In: Annals of Surgery. 2014 ; Vol. 259, No. 5. pp. 973-978.
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abstract = "BACKGROUND: Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE: To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS: A cohort of women with DF and pregnancy was identified from 4 sarcoma centers. Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed. RESULTS: Ninety-two women were included. Forty-four women (48{\%}) had pregnancy-related DF (A + B), whereas 48 (52{\%}) had a history of DF before conception (C + D). Initial treatment was resection in 52{\%}, medical therapy in 4{\%}, and watchful waiting in 43{\%}. Postsurgical relapse rate in A + B was 13{\%}, although progression during watchful waiting was 63{\%}. Relapse/progression in C + D was 42{\%}. After pregnancy, 46{\%} underwent treatment of DF, whereas 54{\%} were managed with watchful waiting. Eventually, only 17{\%} experienced further progression after treatment. Spontaneous regression occurred in 14{\%}. After further pregnancies, only 27{\%} progressed. The only related obstetric event was a cesarean delivery. CONCLUSIONS: Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.",
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author = "Marco Fiore and Sara Coppola and Cannell, {Amanda J.} and Chiara Colombo and Bertagnolli, {Monica M.} and Suzanne George and {Le Cesne}, Axel and Gladdy, {Rebecca A.} and Casali, {Paolo G.} and Swallow, {Carol J.} and Alessandro Gronchi and Sylvie Bonvalot and Raut, {Chandrajit P.}",
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T1 - Desmoid-type fibromatosis and pregnancy

T2 - A multi-institutional analysis of recurrence and obstetric risk

AU - Fiore, Marco

AU - Coppola, Sara

AU - Cannell, Amanda J.

AU - Colombo, Chiara

AU - Bertagnolli, Monica M.

AU - George, Suzanne

AU - Le Cesne, Axel

AU - Gladdy, Rebecca A.

AU - Casali, Paolo G.

AU - Swallow, Carol J.

AU - Gronchi, Alessandro

AU - Bonvalot, Sylvie

AU - Raut, Chandrajit P.

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE: To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS: A cohort of women with DF and pregnancy was identified from 4 sarcoma centers. Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed. RESULTS: Ninety-two women were included. Forty-four women (48%) had pregnancy-related DF (A + B), whereas 48 (52%) had a history of DF before conception (C + D). Initial treatment was resection in 52%, medical therapy in 4%, and watchful waiting in 43%. Postsurgical relapse rate in A + B was 13%, although progression during watchful waiting was 63%. Relapse/progression in C + D was 42%. After pregnancy, 46% underwent treatment of DF, whereas 54% were managed with watchful waiting. Eventually, only 17% experienced further progression after treatment. Spontaneous regression occurred in 14%. After further pregnancies, only 27% progressed. The only related obstetric event was a cesarean delivery. CONCLUSIONS: Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.

AB - BACKGROUND: Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. OBJECTIVE: To investigate the possible relationship between DF and pregnancy. PATIENTS AND METHODS: A cohort of women with DF and pregnancy was identified from 4 sarcoma centers. Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed. RESULTS: Ninety-two women were included. Forty-four women (48%) had pregnancy-related DF (A + B), whereas 48 (52%) had a history of DF before conception (C + D). Initial treatment was resection in 52%, medical therapy in 4%, and watchful waiting in 43%. Postsurgical relapse rate in A + B was 13%, although progression during watchful waiting was 63%. Relapse/progression in C + D was 42%. After pregnancy, 46% underwent treatment of DF, whereas 54% were managed with watchful waiting. Eventually, only 17% experienced further progression after treatment. Spontaneous regression occurred in 14%. After further pregnancies, only 27% progressed. The only related obstetric event was a cesarean delivery. CONCLUSIONS: Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.

KW - aggressive fibromatosis

KW - desmoid-type fibromatosis

KW - pregnancy

KW - prognosis

KW - wait and see

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