Harati Kamran, Jaenisch Anais, Behr Björn, Goertz Ole, Harati Ali, Hirsch Tobias, Stricker Ingo, Lehnhardt Marcus, Daigeler Adrien
Department of Plastic Surgery, BG-University Hospital Bergmannsheil, D-44789 Bochum, Germany.
Department of Neurosurgery, Klinikum Dortmund, D-44145 Dortmund, Germany.
Oncol Lett. 2017 Nov;14(5):5129-5134. doi: 10.3892/ol.2017.6864. Epub 2017 Sep 1.
The treatment of aggressive fibromatosis poses a therapeutic challenge in an interdisciplinary setting. The extent of surgical resection is still discussed controversially. The present retrospective analysis aimed to determine prognostic factors leading to recurrence. Between 2000 and 2014, 114 patients with aggressive fibromatosis were treated surgically at BG-University Hospital Bergmannsheil (Bochum, Germany). Univariate and multivariate analyses were restricted to 90 participants with information available on surgical margins at the initial procedure. The median follow-up time was 7.7 years. A total of 45 patients (50%) developed recurrence during follow-up. Primary tumors were resected with negative margins (R0) in 50 patients (68%) and with microscopically positive margins (R1) in 28 patients (25%). In addition, tumors in 12 patients (7%) were resected with macroscopically positive margins at the initial surgical procedure. The rates of recurrence-free survival (RFS) after 5 years were 68.8% [95% confidence interval (CI), 53.5-79.9%] in patients with R0-resected primary tumors and 34.1% (95% CI, 19.9-48.9%) in patients with R1/R2-status (P=0.001). Narrow and wide clear margins within the R0-group were not associated with significantly different outcomes. Adjuvant radiation, tumor site and patient age were not associated with a significant alteration of RFS. The current results suggest that the attainment of microscopically negative surgical margins at the initial surgical treatment is associated with a significantly improved prognosis. A conservative surgical approach involving the attainment of narrow negative margins while preserving function should be sought in patients in whom tumor resection is indicated. The decision for resection should be made interdisciplinary in each case based on tumor progression, available treatment alternatives and the decision of the informed patient.
侵袭性纤维瘤病的治疗在多学科背景下是一项治疗挑战。手术切除范围仍存在争议。本回顾性分析旨在确定导致复发的预后因素。2000年至2014年期间，114例侵袭性纤维瘤病患者在德国波鸿市贝格曼斯海尔BG大学医院接受了手术治疗。单因素和多因素分析仅限于90例在初次手术时有手术切缘信息的参与者。中位随访时间为7.7年。共有45例患者（50%）在随访期间出现复发。50例患者（68%）的原发性肿瘤切除切缘阴性（R0），28例患者（25%）的切除切缘镜下阳性（R1）。此外，12例患者（7%）的肿瘤在初次手术时切除切缘肉眼阳性。R0切除原发性肿瘤患者的5年无复发生存率（RFS）为68.8%[95%置信区间（CI），53.5 - 79.9%]，R1/R2状态患者为34.1%（95%CI，19.9 - 48.9%）（P = 0.001）。R0组内窄切缘和宽切缘与显著不同的预后无关。辅助放疗、肿瘤部位和患者年龄与RFS的显著改变无关。目前的结果表明，初次手术治疗时获得镜下阴性手术切缘与显著改善的预后相关。对于有肿瘤切除指征的患者，应寻求一种保守的手术方法，即在保留功能的同时获得窄的阴性切缘。在每种情况下，应根据肿瘤进展、可用的治疗选择以及知情患者的决定，跨学科地做出切除决定。
