Effect of surgical margins on prognosis in aggressive fibromatosis: A single‑institutional analysis of 90 patients

Harati,Kamran; Jaenisch,Anais; Behr,Björn; Goertz,Ole; Harati,Ali; Hirsch,Tobias; Stricker,Ingo; Lehnhardt,Marcus; Daigeler,Adrien

doi:10.3892/ol.2017.6864

Effect of surgical margins on prognosis in aggressive fibromatosis: A single‑institutional analysis of 90 patients

Authors:
- Kamran Harati
- Anais Jaenisch
- Björn Behr
- Ole Goertz
- Ali Harati
- Tobias Hirsch
- Ingo Stricker
- Marcus Lehnhardt
- Adrien Daigeler
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Affiliations: Department of Plastic Surgery, BG‑University Hospital Bergmannsheil, D‑44789 Bochum, Germany, Department of Neurosurgery, Klinikum Dortmund, D‑44145 Dortmund, Germany, Institute of Pathology, Ruhr‑University Bochum, D‑44789 Bochum, Germany
Published online on: September 1, 2017 https://doi.org/10.3892/ol.2017.6864
Pages: 5129-5134
Copyright: © Harati et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

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.

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1	Salas S, Dufresne A, Bui B, Blay JY, Terrier P, Ranchere-Vince D, Bonvalot S, Stoeckle E, Guillou L, Le Cesne A, et al: Prognostic factors influencing progression-free survival determined from a series of sporadic desmoid tumors: A wait-and-see policy according to tumor presentation. J Clin Oncol. 29:3553–3558. 2011. View Article : Google Scholar : PubMed/NCBI
2	de Camargo VP, Keohan ML, D'Adamo DR, Antonescu CR, Brennan MF, Singer S, Ahn LS and Maki RG: Clinical outcomes of systemic therapy for patients with deep fibromatosis (desmoid tumor). Cancer. 116:2258–2265. 2010.PubMed/NCBI
3	Dômont J, Salas S, Lacroix L, Brouste V, Saulnier P, Terrier P, Ranchère D, Neuville A, Leroux A, Guillou L, et al: High frequency of beta-catenin heterozygous mutations in extra-abdominal fibromatosis: A potential molecular tool for disease management. Br J Cancer. 102:1032–1036. 2010. View Article : Google Scholar : PubMed/NCBI
4	Mullen JT, DeLaney TF, Rosenberg AE, Le L, Iafrate AJ, Kobayashi W, Szymonifka J, Yeap BY, Chen YL, Harmon DC, et al: β-Catenin mutation status and outcomes in sporadic desmoid tumors. Oncologist. 18:1043–1049. 2013. View Article : Google Scholar : PubMed/NCBI
5	Lazar AJ, Tuvin D, Hajibashi S, Habeeb S, Bolshakov S, Mayordomo-Aranda E, Warneke CL, Lopez-Terrada D, Pollock RE and Lev D: Specific mutations in the beta-catenin gene (CTNNB1) correlate with local recurrence in sporadic desmoid tumors. Am J Pathol. 173:1518–1527. 2008. View Article : Google Scholar : PubMed/NCBI
6	Spear MA, Jennings LC, Mankin HJ, Spiro IJ, Springfield DS, Gebhardt MC, Rosenberg AE, Efird JT and Suit HD: Individualizing management of aggressive fibromatoses. Int J Radiat Oncol Biol Phys. 40:637–645. 1998. View Article : Google Scholar : PubMed/NCBI
7	Ballo MT, Zagars GK, Pollack A, Pisters PW and Pollack RA: Desmoid tumor: Prognostic factors and outcome after surgery, radiation therapy, or combined surgery and radiation therapy. J Clin Oncol. 17:158–167. 1999. View Article : Google Scholar : PubMed/NCBI
8	Merchant NB, Lewis JJ, Woodruff JM, Leung DH and Brennan MF: Extremity and trunk desmoid tumors: A multifactorial analysis of outcome. Cancer. 86:2045–2052. 1999. View Article : Google Scholar : PubMed/NCBI
9	Lewis JJ, Boland PJ, Leung DH, Woodruff JM and Brennan MF: The enigma of desmoid tumors. Ann Surg. 229:866–873. 1999. View Article : Google Scholar : PubMed/NCBI
10	Gronchi A, Casali PG, Mariani L, Lo Vullo S, Colecchia M, Lozza L, Bertulli R, Fiore M, Olmi P, Santinami M and Rosai J: Quality of surgery and outcome in extra-abdominal aggressive fibromatosis: A series of patients surgically treated at a single institution. J Clin Oncol. 21:1390–1397. 2003. View Article : Google Scholar : PubMed/NCBI
11	Crago AM, Denton B, Salas S, Dufresne A, Mezhir JJ, Hameed M, Gonen M, Singer S and Brennan MF: A prognostic nomogram for prediction of recurrence in desmoid fibromatosis. Ann Surg. 258:347–353. 2013. View Article : Google Scholar : PubMed/NCBI
12	Colombo C, Miceli R, Le Péchoux C, Palassini E, Honoré C, Stacchiotti S, Mir O, Casali PG, Dômont J, Fiore M, et al: Sporadic extra abdominal wall desmoid-type fibromatosis: Surgical resection can be safely limited to a minority of patients. Eur J Cancer. 51:186–192. 2015. View Article : Google Scholar : PubMed/NCBI
13	Bonvalot S, Ternès N, Fiore M, Bitsakou G, Colombo C, Honoré C, Marrari A, Le Cesne A, Perrone F, Dunant A and Gronchi A: Spontaneous regression of primary abdominal wall desmoid tumors: More common than previously thought. Ann Surg Oncol. 20:4096–4102. 2013. View Article : Google Scholar : PubMed/NCBI
14	Briand S, Barbier O, Biau D, Bertrand-Vasseur A, Larousserie F, Anract P and Gouin F: Wait-and-see policy as a first-line management for extra-abdominal desmoid tumors. J Bone Joint Surg Am. 96:631–638. 2014. View Article : Google Scholar : PubMed/NCBI
15	Eastley N, Aujla R, Silk R, Richards CJ, McCulloch TA, Esler CP and Ashford RU: Extra-abdominal desmoid fibromatosis-a sarcoma unit review of practice, long term recurrence rates and survival. Eur J Surg Oncol. 40:1125–1130. 2014. View Article : Google Scholar : PubMed/NCBI
16	Shin SH, Ko KR, Cho SK, Choi YL and Seo SW: Surgical outcome of desmoid tumors: Adjuvant radiotherapy delayed the recurrence, but did not affect long-term outcomes. J Surg Oncol. 108:28–33. 2013. View Article : Google Scholar : PubMed/NCBI
17	Lev D, Kotilingam D, Wei C, Ballo MT, Zagars GK, Pisters PW, Lazar AA, Patel SR, Benjamin RS and Pollock RE: Optimizing treatment of desmoid tumors. J Clin Oncol. 25:1785–1791. 2007. View Article : Google Scholar : PubMed/NCBI
18	Schemper M and Smith TL: A note on quantifying follow-up in studies of failure time. Control Clin Trials. 17:343–346. 1996. View Article : Google Scholar : PubMed/NCBI
19	Gronchi A, Colombo C, Le Péchoux C, Dei Tos AP, Le Cesne A, Marrari A, Penel N, Grignani G, Blay JY, Casali PG, et al: Sporadic desmoid-type fibromatosis: A stepwise approach to a non-metastasising neoplasm-a position paper from the Italian and the French Sarcoma Group. Ann Oncol. 25:578–583. 2014. View Article : Google Scholar : PubMed/NCBI
20	Kasper B, Baumgarten C, Bonvalot S, Haas R, Haller F, Hohenberger P, Moreau G, van der Graaf WT and Gronchi A: Desmoid Working Group: Management of sporadic desmoid-type fibromatosis: A European consensus approach based on patients' and professionals' expertise-a sarcoma patients EuroNet and European organisation for research and treatment of cancer/Soft tissue and bone sarcoma group initiative. Eur J Cancer. 51:127–136. 2015. View Article : Google Scholar : PubMed/NCBI