Department of Surgery, Duke University School of Medicine, Durham, NC, USA.
Department of Radiology, Duke University School of Medicine, Durham, NC, USA.
Ann Surg Oncol. 2024 Nov;31(12):7943-7949. doi: 10.1245/s10434-024-15938-x. Epub 2024 Aug 12.
Desmoid tumors (DTs) are rare, fibroblastic cell proliferations that can exhibit locally aggressive behavior but lack metastatic potential. Initial management has traditionally involved upfront resection; however, contemporary guidelines and expert panels have increasingly advocated for prioritizing active surveillance strategies.
A single-institution, retrospective chart review identified all patients diagnosed with a primary DT at any site from 2007 to 2020. The primary outcome was the initial management strategy over time. Secondary outcomes included treatment-free survival (TFS) and time to treatment (TTT) for those undergoing active surveillance, as well as recurrence-free survival (RFS) and time to recurrence for those undergoing resection.
Overall, 103 patients were included, with 68% female and a median follow-up of 44 months [24-74]. The most common tumor locations included the abdominal wall (27%), intra-abdominal/mesenteric (25%), chest wall (19%), and extremity (10%). Initial management included resection (60%), systemic therapy (20%), active surveillance (18%), and cryoablation (2%). Rates of surgical resection significantly decreased (p < 0.001) over time, from 69.6% prior to 2018 to 29.2% after 2018. For those treated with upfront resection, 5-year RFS was 41.2%, and for patients undergoing initial active surveillance, TFS was 66.7% at 2 years, with a median TTT of 4 months [4-10].
This single-institution cohort at a tertiary medical center spanning over a decade demonstrates the transition to active surveillance for initial management of DTs, and highlights salient metrics in the era of surveillance. This trend mirrors recommended treatment strategies by expert panels and consensus guidelines.
硬纤维瘤（DTs）是一种罕见的纤维母细胞增殖性肿瘤，具有局部侵袭性，但缺乏转移潜能。传统上，初始治疗包括直接切除；然而，当代指南和专家小组越来越提倡优先采用主动监测策略。
单中心回顾性病历分析，确定了 2007 年至 2020 年间在任何部位诊断为原发性 DT 的所有患者。主要结局是随时间推移的初始管理策略。次要结局包括接受主动监测的患者的无治疗生存（TFS）和治疗时间（TTT），以及接受切除的患者的无复发生存（RFS）和复发时间。
共纳入 103 例患者，其中 68%为女性，中位随访时间为 44 个月[24-74]。最常见的肿瘤部位包括腹壁（27%）、腹腔/肠系膜（25%）、胸壁（19%）和四肢（10%）。初始治疗包括切除（60%）、系统治疗（20%）、主动监测（18%）和冷冻消融（2%）。手术切除率随时间显著下降（p<0.001），2018 年前为 69.6%，2018 年后为 29.2%。对于接受直接切除的患者，5 年 RFS 为 41.2%，对于初始接受主动监测的患者，2 年 TFS 为 66.7%，中位 TTT 为 4 个月[4-10]。
该单中心十年多的三级医疗中心队列研究表明，在硬纤维瘤的初始管理中，主动监测策略已成为一种趋势，并强调了监测时代的重要指标。这一趋势与专家小组和共识指南推荐的治疗策略一致。
