手术切除与观察作为腹壁纤维瘤初始治疗的比较：一项基于人群的研究。
Surgical excision versus observation as initial management of desmoid tumors: A population based study.
机构信息
Head and Neck Oncologic Surgery & Microvascular Fellowship, 2nd Floor, Faculty Clinics Building University of Florida, Jacksonville 653-1 West 8th Street, Jacksonville, FL, 32209, United States.
Division of Medical Oncology, University of Calgary, Calgary, AB, Canada; Department of Medical Oncology, King Saud University, Riyadh, Saudi Arabia.
出版信息
Eur J Surg Oncol. 2019 Apr;45(4):699-703. doi: 10.1016/j.ejso.2018.09.015. Epub 2018 Oct 25.
SYNOPSIS
Desmoid tumors can be safely managed with watchful waiting, including either observation alone or tamoxifen/NSAIDs. Surgery at first presentation can be associated with significant treatment burden.
BACKGROUND
Immediate surgery was historically recommended for desmoid tumors. Recently, watchful waiting, (tamoxifen/NSAIDs or observation alone), has been advocated.
METHODS
All diagnoses of desmoid tumor within the Alberta Cancer Registry from August 2004 to September 2015 were identified. Patients with FAP were excluded. Demographics, tumor characteristics and treatment and outcome data were collected. Outcomes were compared between immediate surgery and watchful waiting. The effect of abdominal wall site on progression and recurrence and the effect of microscopic margin on recurrence were assessed with Fisher's exact test.
RESULTS
We identified 111 non-FAP patients. Median follow-up was 35 months from diagnosis. 74% were female. Mean age was 42. Fifty (45%) underwent watchful waiting, of whom 21(42%) progressed, with median PFS of 10 months. Fifty-three (48%) underwent resection at presentation, of whom 8 (15%) recurred, with median disease-free survival of 22 months. Abdominal wall lesions were equally represented in both groups, and equally likely to progress on watchful waiting (50% vs 39%, p = 0.53), but there was a trend toward decreased recurrence after surgery. (5% vs 23%, p = 0.08). Microscopic margin had no effect on recurrence (14% of margin negative vs 20% of margin positive, p = 1.0).
CONCLUSIONS
Watchful waiting was successful in 58% of patients, and a further 28% only required one aggressive treatment thereafter, for a total of 86%. Surgery had a favorable recurrence rate (15%), but some recurrences were associated with significant treatment burden. Treatment should be tailored to individual patients in a multidisciplinary setting. A trial of observation appears warranted in most patients. Recurrence rate was not affected by positive margins.
摘要
观察等待（包括单独观察或他莫昔芬/非甾体抗炎药）可安全管理硬纤维瘤，可以避免初次就诊时即进行手术带来的巨大治疗负担。
背景
过去，临床上建议对硬纤维瘤患者行即刻手术治疗。而最近，观察等待（他莫昔芬/非甾体抗炎药或单独观察）已被提倡用于治疗硬纤维瘤。
方法
在 2004 年 8 月至 2015 年 9 月期间，通过艾伯塔癌症登记处确定了所有硬纤维瘤患者。排除有家族性息肉病的患者。收集患者的人口统计学、肿瘤特征以及治疗和预后数据。比较即刻手术和观察等待的治疗效果。采用 Fisher 精确检验评估腹壁部位对进展和复发的影响以及显微镜下切缘对复发的影响。
结果
共纳入 111 例非家族性息肉病患者。从诊断到随访的中位时间为 35 个月。74%为女性，平均年龄为 42 岁。50 例（45%）患者接受观察等待治疗，其中 21 例（42%）出现进展，无进展生存期的中位时间为 10 个月。53 例（48%）患者行初次手术切除，其中 8 例（15%）复发，无病生存期的中位时间为 22 个月。两组中腹壁病变的比例相当，且在观察等待时同样容易出现进展（50%比 39%，p=0.53），但手术后复发的风险较低（5%比 23%，p=0.08）。显微镜下切缘对复发无影响（切缘阴性患者的复发率为 14%，切缘阳性患者的复发率为 20%，p=1.0）。
结论
观察等待在 58%的患者中取得成功，此后仅 28%的患者需要接受进一步的侵袭性治疗，总的成功率为 86%。手术的复发率较低（15%），但部分复发患者需要接受负担较重的治疗。应在多学科背景下根据个体患者的具体情况制定治疗方案。在大多数患者中，观察治疗似乎是合理的。切缘状态不影响复发率。
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