Document Detail


A prognostic nomogram for prediction of recurrence in desmoid fibromatosis.
MedLine Citation:
PMID:  23532110     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To construct a postoperative nomogram to estimate the risk of local recurrence for patients with desmoid tumors.
BACKGROUND: The standard management of desmoid tumors is resection, but many recur locally. Other options include observation or novel chemotherapeutics, but little guidance exists on selecting treatment.
METHODS: Patients undergoing resection during 1982-2011 for primary or locally recurrent desmoids were identified from a single-institution prospective database. Cox regression analysis was used to assess risk factors and to create a recurrence nomogram, which was validated using an international, multi-institutional data set.
RESULTS: Desmoids were treated surgically in 495 patients (median follow-up of 60 months). Of 439 patients undergoing complete gross resection, 100 (23%) had recurrence. Five-year local recurrence-free survival was 69%. Eight patients died of disease, all after R2 resection. Adjuvant radiation was not associated with improved local recurrence-free survival. In multivariate analysis, factors associated with recurrence were extremity location, young age, and large tumor size, but not margin. Abdominal wall tumors had the best outcome (5-year local recurrence-free survival rate of 91%). Age, site, and size were used to construct a nomogram with concordance index of 0.703 in internal validation and 0.659 in external validation. Integration of additional variables (R1 margin, sex, depth, and primary vs recurrent presentation) did not importantly improve concordance (internal concordance index of 0.707).
CONCLUSIONS: A postoperative nomogram including only size, site, and age predicts local recurrence and can aid in counseling patients. Systemic therapies may be appropriate for young patients with large, extremity desmoids, but surgery alone is curative for most abdominal wall lesions.
Authors:
Aimeé M Crago; Brian Denton; Sébastien Salas; Armelle Dufresne; James J Mezhir; Meera Hameed; Mithat Gonen; Samuel Singer; Murray F Brennan
Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Annals of surgery     Volume:  258     ISSN:  1528-1140     ISO Abbreviation:  Ann. Surg.     Publication Date:  2013 Aug 
Date Detail:
Created Date:  2013-07-10     Completed Date:  2013-09-10     Revised Date:  2014-08-03    
Medline Journal Info:
Nlm Unique ID:  0372354     Medline TA:  Ann Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  347-53     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Decision Support Techniques*
Female
Fibromatosis, Aggressive / mortality,  surgery*
Follow-Up Studies
Humans
Male
Middle Aged
Multivariate Analysis
Neoplasm Recurrence, Local / diagnosis*,  etiology,  mortality
Nomograms*
Patient Selection
Risk Assessment
Risk Factors
Survival Analysis
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
L30 CA163090/CA/NCI NIH HHS; P01 CA047179/CA/NCI NIH HHS; P01CA047179/CA/NCI NIH HHS
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