Kamali Firouzeh, Wang Wei-Lien, Guadagnolo B A, Fox Patricia S, Lewis Valerae O, Lazar Alexander J, Conley Anthony P, Ravi Vinod, Toliyat Mohammad, Ladha Harshad S, Hobbs Brian P, Amini Behrang
1 Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
2 Department of Diagnostic Radiology, University of Texas at Houston, Houston, TX, USA.
Br J Radiol. 2016;89(1058):20150308. doi: 10.1259/bjr.20150308. Epub 2015 Nov 18.
To determine the association of MRI features of extra-abdominal desmoid tumours (DTs) with prognosis.
MRIs for 90 patients with DT were retrospectively reviewed for imaging features associated with biological behaviour. The primary end point was progression (for lesions managed with chemotherapy, radiation therapy and observation) or recurrence (following surgery). Time to event was studied using univariate and multivariable Cox proportional hazards regression models when accounting for demographic, clinicopathological and imaging variables. Kaplan-Meier plots were used to estimate event-free rate (EFR).
Univariate analysis revealed a significant relationship between EFR and treatment, location and compartment of origin [subcutaneous (SC), superficial fascial, intramuscular (IM) and deep fascial/intermuscular]. None of the imaging features commonly associated with biological behaviour of DTs (e.g., shape, enhancement, T2 signal etc.) or surgical margins (in surgical cases) was associated with EFR. Multivariate analysis showed that treatment modality and compartment of origin were independent predictors of EFR. Superficial and deep fascial lesions had a significantly worse EFR as a group [hazard ratio: 3.9; 95% confidence interval (CI): 1.83-8.32; p = 0.0004] than did the SC and IM lesions as a group. 5-year EFR for the fascial lesions was 18% (95% CI: 6-36%), compared with 57% (95% CI: 25-79%) for the SC and IM groups.
Intramuscular or SC DTs may be associated with improved prognosis. If validated on multireader and prospective studies, these results can provide for rapid risk stratification at the time of initial MRI.
This work has shown that imaging features commonly associated with biological activity of desmoid tumours (e.g. shape, T2 signal and enhancement) do not appear to be associated with prognosis in patients undergoing a variety of treatment modalities. The compartment of origin of the lesion, which can be determined on pre-operative MRI, was shown to be associated with prognosis and can allow for risk stratification in patients with DTs.
确定腹壁外硬纤维瘤（DTs）的MRI特征与预后的相关性。
回顾性分析90例DT患者的MRI，以寻找与生物学行为相关的影像特征。主要终点为进展（对于接受化疗、放疗和观察的病变）或复发（手术后）。在考虑人口统计学、临床病理和影像变量时，使用单变量和多变量Cox比例风险回归模型研究至事件发生时间。采用Kaplan-Meier曲线估计无事件发生率（EFR）。
单变量分析显示EFR与治疗、起源部位和分区[皮下（SC）、浅筋膜、肌内（IM）和深筋膜/肌间]之间存在显著关系。DTs生物学行为通常相关的影像特征（如形状、强化、T2信号等）或手术切缘（手术病例）均与EFR无关。多变量分析表明，治疗方式和起源分区是EFR的独立预测因素。浅筋膜和深筋膜病变组的EFR明显低于SC和IM病变组[风险比：3.9；95%置信区间（CI）：1.83-8.32；p = 0.0004]。筋膜病变的5年EFR为18%（95%CI：6-36%），而SC和IM组为57%（95%CI：25-79%）。
肌内或SC DTs可能与预后改善相关。如果在多阅片者和前瞻性研究中得到验证，这些结果可为初始MRI检查时的快速风险分层提供依据。
这项研究表明，DTs生物学活性通常相关的影像特征（如形状、T2信号和强化）似乎与接受各种治疗方式的患者的预后无关。术前MRI可确定的病变起源分区与预后相关，可用于DTs患者的风险分层。
