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优化硬纤维瘤的治疗

Optimizing treatment of desmoid tumors.

作者信息

Lev Dina, Kotilingam Dhanasekaran, Wei Caimiao, Ballo Matthew T, Zagars Gunar K, Pisters Peter W T, Lazar Alexander A, Patel Shreyaskumar R, Benjamin Robert S, Pollock Raphael E

机构信息

Department of Cancer Biology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.

出版信息

J Clin Oncol. 2007 May 1;25(13):1785-91. doi: 10.1200/JCO.2006.10.5015.

DOI:10.1200/JCO.2006.10.5015
PMID:17470870
Abstract

PURPOSE

This study compared a large series of desmoid patients treated at a single institution to a previously published series from the same institution to determine if patient population characteristics, treatment approaches, and clinical outcomes had undergone change over the two study periods.

MATERIALS AND METHODS

Data from a prospective soft tissue tumor database was used to analyze clinical courses of 189 desmoid patients treated at The University of Texas M.D. Anderson Cancer Center (UTMDACC) from 1995 to 2005 as compared with 189 UTMDACC desmoid patients treated between 1965 and 1994.

RESULTS

A nearly three-fold increase in annualized UTMDACC desmoid referral volume with significantly higher percentages and numbers of primary desmoid tumor referrals to UTMDACC was observed in the most recent study period. Significantly increased systemic therapy use and decreased reliance on surgery alone was observed more recently. While the recent series patients had higher rates of macroscopic residual disease and equivalent rates of positive microscopic margins after definitive surgery, the estimated 5-year local recurrence rate of 20% was improved compared with the 30% rate observed in the earlier series.

CONCLUSION

Increased awareness of the complex multidisciplinary management needed for desmoid tumor control may underlie significantly increased numbers of referrals to UTMDACC, especially primary untreated desmoids. Increased neoadjuvant treatments may be associated with improved desmoid patient outcomes. These trends should be supported, particularly if personalized molecular-based therapies are to be rapidly and effectively deployed for the benefit of those afflicted by this rare and potentially debilitating disease.

摘要

目的

本研究将在单一机构接受治疗的大量硬纤维瘤患者与该机构之前发表的系列病例进行比较,以确定在两个研究期间患者群体特征、治疗方法和临床结果是否发生了变化。

材料与方法

利用前瞻性软组织肿瘤数据库的数据,分析了1995年至2005年在德克萨斯大学MD安德森癌症中心(UTMDACC)接受治疗的189例硬纤维瘤患者的临床病程,并与1965年至1994年期间在UTMDACC接受治疗的189例硬纤维瘤患者进行比较。

结果

在最近的研究期间,UTMDACC硬纤维瘤转诊量年化增长近三倍,转诊至UTMDACC的原发性硬纤维瘤肿瘤的百分比和数量显著更高。最近观察到全身治疗的使用显著增加,对单纯手术的依赖减少。虽然最近一组患者在根治性手术后宏观残留疾病发生率较高,显微镜下切缘阳性率相当,但估计5年局部复发率为20%,较早期一组观察到的30%有所改善。

结论

对硬纤维瘤肿瘤控制所需的复杂多学科管理的认识提高,可能是转诊至UTMDACC的患者数量显著增加的原因,尤其是原发性未经治疗的硬纤维瘤。新辅助治疗的增加可能与硬纤维瘤患者预后改善有关。应支持这些趋势,特别是如果要迅速有效地部署基于个性化分子的疗法,以造福于患有这种罕见且可能使人衰弱的疾病的患者。

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