PDF(Pubmed)
Abstract：
In patients with desmoid tumors (DTs), active surveillance has been increasingly preferred over surgery, while treatment (including pharmacological therapy, radiotherapy, and/or surgery) is performed in cases with confirmed disease progression. This study aimed to evaluate event-free survival and pain management according to different treatment strategies. We evaluated event-free survival, including recurrence after initial surgical treatment or changes in the therapeutic management after initial non-surgical treatment and pain management according to different treatment strategies. All patients referred for DT in 2001-2021 at our institutions were stratified into four groups: those treated surgically prior to 2012 (SGPre12) or after 2012 (SGPost12), those treated pharmacologically (MG), and those under active surveillance (ASG). An event was defined as recurrence after initial surgical treatment or a change in therapeutic management. Overall, 123 patients were included in the study: 28 in SGPre12, 41 in SGPost12, 38 in MG, and 16 in ASG. Pharmacological treatment resolved painful symptoms in 16/27 (60%) patients (p = 0.0001). The median follow-up duration was 40 months (IQR 23-74). Event-free survival at 1, 3, and 5 years was: 85%, 70%, and 62% in SGPre12; 76%, 58%, and 49% in SGPost12; 49%, 31%, and 31% in MG; and 45%, 45%, and 45% in ASG. Our findings support the role of active surveillance as initial management, as demonstrated by the fact that about half the patients did not experience any progression, while surgery can be reserved as a first-line approach for selected patients. In terms of pain relief, medical therapy led to symptom resolution in more than half the cases.
摘要：
在纤维瘤（DTs）患者中，主动监测越来越优于手术，而治疗(包括药物治疗，放射治疗,和/或手术）在确诊疾病进展的情况下进行。本研究旨在根据不同的治疗策略评估无事件生存率和疼痛管理。我们评估了无事件生存率，包括初始手术治疗后的复发或初始非手术治疗后治疗管理的变化以及根据不同治疗策略的疼痛管理。我们机构在2001-2021年转诊为DT的所有患者均分为四组：2012年之前（SGPre12）或2012年之后（SGPost12）接受手术治疗的患者。那些药理学治疗（MG），和那些在积极监测（ASG）。事件定义为初始手术治疗后复发或治疗管理改变。总的来说,123例患者纳入研究：SGPre1228例，SGPost1241例，MG38例，和16在ASG。药物治疗解决了16/27（60％）患者的疼痛症状（p=0.0001）。中位随访时间为40个月（IQR23-74）。1、3和5年的无事件生存率为：85％，70%,SGPre12为62%；76%，58%,SGPost12占49%；49%，31%,MG占31%；45%，45%,和45%的ASG。我们的发现支持主动监测作为初始管理的作用，事实证明，大约一半的患者没有任何进展，而手术可以保留为选定患者的一线方法。在缓解疼痛方面，在超过一半的病例中，药物治疗导致症状缓解。
