Recurrence and prognostic factors in patients with aggressive fibromatosis. The role of radical surgery and its limitations

Emilio Bertani, Alessandro Testori, Antonio Chiappa, Pasquale Misitano, Roberto Biffi, Giuseppe Viale, Giovanni Mazzarol, Tommaso De Pas, Edoardo Botteri, Gianmarco Contino, Francesco Verrecchia, Barbara Bazolli, Bruno Andreoni

Research output: Contribution to journalArticle

Abstract

Background: Surgery is still the standard treatment for aggressive fibromatosis (AF); however, local control remains a significant problem and the impact of R0 surgery on cumulative recurrence (CR) is objective of contradictory reports.Methods: This is a single-institution study of 62 consecutive patients affected by extra-abdominal and intra-abdominal AF who received macroscopically radical surgery within a time period of 15 years.Results: Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13 patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1% vs 46.4% (P = 0.04) and for limbs vs other localizations 33.3% vs 9.9% (P = 0.02) respectively. In 17 patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was more common (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0% vs 19.1%, respectively, P = 0.04). However, in multivariate analysis only limb localization showed a negative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04).Conclusions: IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment, including watchful follow-up, could be indicated for patients with limb AF localization, because of their high risk of recurrence even after R0 surgery.

Original languageEnglish
Article number184
JournalWorld Journal of Surgical Oncology
Volume10
DOIs
Publication statusPublished - Sep 10 2012

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Aggressive Fibromatosis
Recurrence
Extremities
Frozen Sections
Abdominal Fibromatosis
Multivariate Analysis
Pathology
Therapeutics

Keywords

  • Aggressive fibromatosis
  • Desmoid tumors
  • Frozen sections
  • Local recurrence
  • Risk factors
  • Surgery

ASJC Scopus subject areas

  • Oncology
  • Surgery

Cite this

@article{a4442b10dabc466e95a6c76b4990a8d6,
title = "Recurrence and prognostic factors in patients with aggressive fibromatosis. The role of radical surgery and its limitations",
abstract = "Background: Surgery is still the standard treatment for aggressive fibromatosis (AF); however, local control remains a significant problem and the impact of R0 surgery on cumulative recurrence (CR) is objective of contradictory reports.Methods: This is a single-institution study of 62 consecutive patients affected by extra-abdominal and intra-abdominal AF who received macroscopically radical surgery within a time period of 15 years.Results: Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13 patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1{\%} vs 46.4{\%} (P = 0.04) and for limbs vs other localizations 33.3{\%} vs 9.9{\%} (P = 0.02) respectively. In 17 patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was more common (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0{\%} vs 19.1{\%}, respectively, P = 0.04). However, in multivariate analysis only limb localization showed a negative impact on CR (HR: 1.708, 95{\%} CI 1.03 to 2.84, P = 0.04).Conclusions: IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment, including watchful follow-up, could be indicated for patients with limb AF localization, because of their high risk of recurrence even after R0 surgery.",
keywords = "Aggressive fibromatosis, Desmoid tumors, Frozen sections, Local recurrence, Risk factors, Surgery",
author = "Emilio Bertani and Alessandro Testori and Antonio Chiappa and Pasquale Misitano and Roberto Biffi and Giuseppe Viale and Giovanni Mazzarol and {De Pas}, Tommaso and Edoardo Botteri and Gianmarco Contino and Francesco Verrecchia and Barbara Bazolli and Bruno Andreoni",
year = "2012",
month = "9",
day = "10",
doi = "10.1186/1477-7819-10-184",
language = "English",
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journal = "World Journal of Surgical Oncology",
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TY - JOUR

T1 - Recurrence and prognostic factors in patients with aggressive fibromatosis. The role of radical surgery and its limitations

AU - Bertani, Emilio

AU - Testori, Alessandro

AU - Chiappa, Antonio

AU - Misitano, Pasquale

AU - Biffi, Roberto

AU - Viale, Giuseppe

AU - Mazzarol, Giovanni

AU - De Pas, Tommaso

AU - Botteri, Edoardo

AU - Contino, Gianmarco

AU - Verrecchia, Francesco

AU - Bazolli, Barbara

AU - Andreoni, Bruno

PY - 2012/9/10

Y1 - 2012/9/10

N2 - Background: Surgery is still the standard treatment for aggressive fibromatosis (AF); however, local control remains a significant problem and the impact of R0 surgery on cumulative recurrence (CR) is objective of contradictory reports.Methods: This is a single-institution study of 62 consecutive patients affected by extra-abdominal and intra-abdominal AF who received macroscopically radical surgery within a time period of 15 years.Results: Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13 patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1% vs 46.4% (P = 0.04) and for limbs vs other localizations 33.3% vs 9.9% (P = 0.02) respectively. In 17 patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was more common (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0% vs 19.1%, respectively, P = 0.04). However, in multivariate analysis only limb localization showed a negative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04).Conclusions: IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment, including watchful follow-up, could be indicated for patients with limb AF localization, because of their high risk of recurrence even after R0 surgery.

AB - Background: Surgery is still the standard treatment for aggressive fibromatosis (AF); however, local control remains a significant problem and the impact of R0 surgery on cumulative recurrence (CR) is objective of contradictory reports.Methods: This is a single-institution study of 62 consecutive patients affected by extra-abdominal and intra-abdominal AF who received macroscopically radical surgery within a time period of 15 years.Results: Definitive pathology examination confirmed an R0 situation in 49 patients and an R1 in 13 patients. Five-year CR for patients who underwent R0 vs R1 surgery was 7.1% vs 46.4% (P = 0.04) and for limbs vs other localizations 33.3% vs 9.9% (P = 0.02) respectively. In 17 patients who had intraoperative frozen section (IFS) margin evaluation R0 surgery was more common (17 of 17 vs 32 of 45, P = 0.01) and CR lower (five-year CR 0% vs 19.1%, respectively, P = 0.04). However, in multivariate analysis only limb localization showed a negative impact on CR (HR: 1.708, 95% CI 1.03 to 2.84, P = 0.04).Conclusions: IFS evaluation could help the surgeon to achieve R0 surgery in AF. Non-surgical treatment, including watchful follow-up, could be indicated for patients with limb AF localization, because of their high risk of recurrence even after R0 surgery.

KW - Aggressive fibromatosis

KW - Desmoid tumors

KW - Frozen sections

KW - Local recurrence

KW - Risk factors

KW - Surgery

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SN - 1477-7819

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