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Carrillo-García J, Hindi N, Conceicao M, Sala MÁ, Ugalde A, López-Pousa A, Bagué S, Sevilla I, Vicioso L, Ramos R, Martínez-Trufero J, Gómez Mateo MC, Cruz J, Hernández-León CN, Redondo A, Mendiola M, García JM, Hernández JE, Álvarez R, Agra C, de Juan-Ferré A, Valverde C, Cano JM, Sande LMD, Pérez-Fidalgo JA, Lavernia J, Marcilla D, Gutiérrez A, Moura DS, Martín-Broto J. Prognostic impact of tumor location and gene expression profile in sporadic desmoid tumor. Eur J Cancer 2024; 209:114270. [PMID: 39142211 DOI: 10.1016/j.ejca.2024.114270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2024] [Revised: 07/26/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Abstract
PURPOSE Prognostic biomarkers remain necessary in sporadic desmoid tumor (DT) because the clinical course is unpredictable. DT location along with gene expression between thoracic and abdominal wall locations was analyzed. METHOD Sporadic DT patients (GEIS Registry) diagnosed between 1982 and 2018 who underwent upfront surgery were enrolled retrospectively in this study. The primary endpoint was relapse-free survival (RFS). Additionally, the gene expression profile was analyzed in DT localized in the thoracic or abdominal wall, harboring the most frequent CTNNB1 T41A mutation. RESULTS From a total of 454 DT patients, 197 patients with sporadic DT were selected. The median age was 38.2 years (1.8-89.1) with a male/female distribution of 33.5/66.5. Most of them harbored the CTNNB1 T41A mutation (71.6 %), followed by S45F (17.8 %) and S45P (4.1 %). A significant worse median RFS was associated with males (p = 0.019), tumor size ≥ 6 cm (p = 0.001), extra-abdominal DT location (p < 0.001) and the presence of CTNNB1 S45F mutation (p = 0.013). In the multivariate analysis, extra-abdominal DT location, CTNNB1 S45F mutation and tumor size were independent prognostic biomarkers for worse RFS. DTs harboring the CTNNB1 T41A mutation showed overexpression of DUSP1, SOCS1, EGR1, FOS, LIF, MYC, SGK1, SLC2A3, and IER3, and underexpression of BMP4, PMS2, HOXA9, and WISP1 in thoracic versus abdominal wall locations. CONCLUSION Sporadic DT location exhibits a different prognosis in terms of RFS favoring the abdominal wall compared to extra-abdominal sites. A differential gene expression profile under the same CTNNB1 T41A mutation is observed in the abdominal wall versus the thoracic wall, mainly affecting the Wnt/β-catenin, TGFβ, IFN, and TNF pathways.
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Affiliation(s)
- Jaime Carrillo-García
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain; Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain.
| | - Nadia Hindi
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain; Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain; Medical Oncology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain.
| | | | - María Ángeles Sala
- Medical Oncology Department, Basurto University Hospital, Bilbao, Spain.
| | - Aitziber Ugalde
- Pathology Department, Basurto University Hospital, Bilbao, Spain.
| | - Antonio López-Pousa
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Silvia Bagué
- Pathology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Isabel Sevilla
- Clinical and Translational Research in Cancer/Biomedical Reseach Institute of Malaga (IBIMA), University Hospitals Regional and Virgen de la Victoria, Malaga, Spain.
| | - Luis Vicioso
- Pathology Department, University Hospital Virgen de la Victoria, IBIMA-Plataforma Bionand, Malaga, Spain.
| | - Rafael Ramos
- Pathology Department, University Hospital Son Espases, Palma, Spain.
| | | | | | - Josefina Cruz
- Medical Oncology Department, University Hospital of Canarias, Santa Cruz de Tenerife, Spain.
| | | | - Andrés Redondo
- Medical Oncology Department, University Hospital La Paz-IdiPAZ, Madrid, Spain.
| | - Marta Mendiola
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, Madrid, Spain; Hospital La Paz Institute for Health Research - IDIPAZ, La Paz University Hospital, Madrid, Spain.
| | | | | | - Rosa Álvarez
- Medical Oncology Department, University Hospital Gregorio Marañón, Madrid, Spain.
| | - Carolina Agra
- Pathology Department, University Hospital Gregorio Marañón, Madrid, Spain.
| | - Ana de Juan-Ferré
- Medical Oncology Department, University Hospital Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - Claudia Valverde
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | - Juana María Cano
- Medical Oncology Department, University Hospital of Ciudad Real, Ciudad Real, Spain.
| | | | - José A Pérez-Fidalgo
- Hematology and Medical Oncology Department, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain.
| | - Javier Lavernia
- Oncology Department, Instituto Valenciano de Oncología, Valencia, Spain.
| | - David Marcilla
- Pathology Department, University Hospital Virgen del Rocío, Sevilla, Spain.
| | - Antonio Gutiérrez
- Department of Haematology, University Hospital Son Espases, IdISBa, Palma, Spain.
| | - David S Moura
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain; Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain.
| | - Javier Martín-Broto
- Health Research Institute Fundación Jiménez Díaz (IIS-FJD, UAM), Madrid, Spain; Medical Oncology Department, University Hospital General de Villalba, Madrid, Spain; Medical Oncology Department, University Hospital Fundación Jiménez Díaz, Madrid, Spain.
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Xie M, Huang Q, Gong T, Wang Y, Li Z, Lu M, Luo Y, Min L, Zhou Y, Tu C. Efficacy and safety of anlotinib in patients with desmoid fibromatosis: a retrospective analysis. Front Oncol 2024; 14:1399574. [PMID: 38807768 PMCID: PMC11130419 DOI: 10.3389/fonc.2024.1399574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 04/30/2024] [Indexed: 05/30/2024] Open
Abstract
Introduction Desmoid fibromatosis is an aggressive fibroblastic neoplasm with a high propensity for local recurrence. Targeted therapy for Desmoid fibromatosis represents a novel avenue in systemic treatment. Anlotinib, a novel multitargeted angiogenesis inhibitor, represents a novel approach for targeted therapy. Therefore, this study aims to assess the efficacy and safety of anlotinib in patients with Desmoid fibromatosis. Methods We retrospectively gathered the clinical medical records of Desmoid fibromatosis patients who underwent anlotinib treatment between June 2019 and November 2023 at our center. Anlotinib was initiated at a daily dose of 12 mg and adjusted based on drug-related toxicity. Tumor response was evaluated using the Response Evaluation Criteria in Solid Tumors 1.1 criteria. Progression-free survival served as the primary endpoint and was analyzed utilizing the Kaplan-Meier method. Results In total, sixty-six consecutive patients were enrolled. No patients achieved a complete response; however, fourteen patients (21.21%) exhibited a partial response, while forty-six patients (70%) experienced disease stability. Progressive disease was observed in 6 patients (9.10%), and the progression-free survival rates at 12 and 36months were 89.71% and 82.81%, respectively. The disease control rate was 90.91%, while the objective response rate was 21.21%. Conclusion Anlotinib proves effective in managing recurrent and symptomatic patients with Desmoid fibromatosis. However, the toxicity profile of anlotinib presents a higher risk of Hand-Foot Skin Reaction and hypertension. Therefore, given that 41.67% of patients were subjected to dose adjustments associated with the initial dose of 12 mg, implementing dosage reductions may help balance efficacy with side effects.
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Affiliation(s)
- Mengzhang Xie
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Qi Huang
- Operating Room, West china Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Taojun Gong
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Yitian Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Zhuangzhuang Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Minxun Lu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Yi Luo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Li Min
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Yong Zhou
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
| | - Chongqi Tu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan Province, Chengdu, Sichuan, China
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Denwood H, Gonzalez MR, Sodhi A, Werenski J, Clunk M, Newman ET, Lozano-Calderón SA. Risk factors for local recurrence of upper extremity desmoid tumors. J Surg Oncol 2024; 129:813-819. [PMID: 38073165 DOI: 10.1002/jso.27559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/14/2023] [Accepted: 11/30/2023] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Upper extremity (UE) desmoid tumors are locally aggressive neoplasms with high recurrence rates. Our study sought to analyze the demographics and treatment strategies of UE desmoid tumors and identify risk factors for recurrence. MATERIALS AND METHODS A retrospective review of 52 patients with histologically confirmed UE desmoid tumors treated at our institution between 1990 and 2015 was conducted. Survival was assessed using the Kaplan-Meier method and the Cox proportional hazards model was used for risk factor analysis. RESULTS For the entire cohort, median age was 40 (29-47) years, 75% were female, and 48% had local recurrence. The median tumor size was 45 (15-111) cm3 on imaging. Twenty-two patients had a previous resection. The most common treatments were surgery alone (50%) and surgery with adjuvant radiotherapy (21%). Tumor size ≥5 cm and tumor volume ≥40 cm3 on imaging were associated with increased recurrence (p = 0.006 and p = 0.005, respectively). Age and sex were not associated with local recurrence. Patients with a tumor size ≥5 cm were 2.6 times more likely to present with recurrence. At the 10-year mark, a lower local recurrence-free survival was seen in patients with tumors ≥5 cm (72.2% vs. 36.3%, p = 0.042) or ≥40 cm3 (67.2% vs. 32.7%, p = 0.034). CONCLUSION In our study, only tumor dimensions appeared to modify recurrence risk.
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Affiliation(s)
- Hayley Denwood
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Marcos R Gonzalez
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alisha Sodhi
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph Werenski
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marilee Clunk
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
- University of Toledo College of Medicine and Life Sciences Toledo, Toledo, Ohio, USA
| | - Erik T Newman
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Santiago A Lozano-Calderón
- Department of Orthopaedic Surgery, Harvard Medical School, Division of Orthopaedic Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Yang W, Ding PR. Update on Familial Adenomatous Polyposis-Associated Desmoid Tumors. Clin Colon Rectal Surg 2023; 36:400-405. [PMID: 37795470 PMCID: PMC10547538 DOI: 10.1055/s-0043-1767709] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Desmoid tumors (DT) represent the second high risk of tumor in familial adenomatous polyposis (FAP) patients. Although FAP-associated DTs (FAP-DT) are caused by germline mutations in the adenomatous polyposis coli (APC) gene, extracolonic manifestations, sex, family history, genotype, and the ileal pouch anal anastomosis procedure are all linked to the development of DTs in FAP patients. Multidisciplinary management has replaced aggressive surgery as the preferred treatment of DTs. There is growing evidence to support the use of active surveillance strategy as first-line treatment for FAP-DT patients. Radiotherapy for intra-abdominal desmoids is now rarely used because of severe late toxicity. Pharmacotherapy, however, represents a promising future with the improvement of traditional cytotoxic drugs and the investigation of targeted drugs. Although nonsurgery treatment has been used widely nowadays, surgery remains the mainstay when symptomatic or life-threatening DTs are present. Further research will be needed for more optimal clinical practice.
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Affiliation(s)
- Wanjun Yang
- Department of Colorectal Cancer, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Pei-Rong Ding
- Department of Colorectal Cancer, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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Asaad SK, Abdullah AM, Abdalrahman SA, Fattah FH, Tahir SH, Omer CS, Rashid RJ, Hassan MN, Mohammed SH, Kakamad FH, Abdalla BA. Extra‑abdominal recurrent aggressive fibromatosis: A case series and a literature review. Mol Clin Oncol 2023; 19:84. [PMID: 37808248 PMCID: PMC10557105 DOI: 10.3892/mco.2023.2680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 08/22/2023] [Indexed: 10/10/2023] Open
Abstract
Aggressive fibromatosis is a rare clonal proliferative tumor arising from mesenchymal cells in the fascia and musculoaponeurotic structures. The aim of the present study was to describe several cases of extra-abdominal recurrent aggressive fibromatosis. The present study was a single-center retrospective case series of patients with recurrent aggressive fibromatosis. The cases were managed at a single private facility. A total of 9 patients with recurrent fibromatosis were included. The mean and median ages of the patients were 29 and 30 years, respectively. In total, two thirds (66.67%) of the cases were female. A negative previous medical history was reported in 7 cases (77.7%), and diabetes and hypertension were reported in 1 case (11.1%). Overall, only 1 case (11.1%) had a family history of breast fibromatosis. The time interval between primary tumor resection and recurrent presentation was 28 months. In 6 cases (66.7%), the tumor was located in the extremities. Pain was the most common presenting symptom in 6 cases (66.7%). All patients had their recurring tumor surgically removed, followed by radiation in 5 cases. The resection margin was positive in 4 cases (44.4%). Each patient was subjected to a careful three-month follow-up for recurrences. On the whole, the present study demonstrates that despite the fact that several therapeutic approaches for extra-abdominal recurrent aggressive fibromatosis have been described in the literature, there is a significant likelihood of recurrence following resection.
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Affiliation(s)
- Saywan K. Asaad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
| | - Ari M. Abdullah
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Sulaimani Teaching Hospital, Sulaimani, Kurdistan 46001, Iraq
| | | | - Fattah H. Fattah
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
| | - Soran H. Tahir
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
| | - Choman Sabah Omer
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
| | - Rezheen J. Rashid
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Department of Radiology, Hiwa Hospital, Sulaimani, Kurdistan 46001, Iraq
| | - Marwan N. Hassan
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan 46001, Iraq
| | - Shvan H. Mohammed
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan 46001, Iraq
| | - Fahmi H. Kakamad
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- College of Medicine, University of Sulaimani, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan 46001, Iraq
| | - Berun A. Abdalla
- Department of Scientific Affairs, Smart Health Tower, Sulaimani, Kurdistan 46001, Iraq
- Kscien Organization, Hamdi Str, Azadi Mall, Sulaimani, Kurdistan 46001, Iraq
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Sakai T, Nishida Y, Ito K, Ikuta K, Urakawa H, Koike H, Imagama S. Clinical results of active surveillance for extra-abdominal desmoid-type fibromatosis. Cancer Med 2023; 12:5245-5254. [PMID: 36210645 PMCID: PMC10028109 DOI: 10.1002/cam4.5329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The treatment of choice for desmoid-type fibromatosis (DF) has been changed to active surveillance (AS). However, few studies have reported clinical outcomes of AS modality in Asian countries. This study aimed to clarify the significance of AS as a DF treatment modality. METHODS A total of 168 lesions from 162 patients with extra-abdominal DF were included. The mean age at diagnosis was 39 years (1-88 years), and the median maximum tumor diameter at the first visit was 64.1 mm (13.2-255.8 mm). The clinical outcomes of AS and the risk factors requiring active treatment (AT) (defined as an event) from AS modality were investigated. RESULTS Of the 168 lesions, 94 (56%) were able to continue AS, with a 5-year event-free survival of 54.8%. Of the 68 lesions with PD, 21 (30.9%) lesions were able to continue AS. Neck location (p = 0.043) and CTNNB1 S45F mutation (p = 0.003) were significantly associated with the transition to AT, and S45F mutation was a significant factor associated with the transition to AT by multivariate analysis (hazard ratio: 1.96, p = 0.048). AT outcomes after AS were evaluable in 65 lesions, and 49 (75%) lesions did not require a transition to a second AT. CONCLUSIONS AS was revealed as an effective treatment modality. The transition to AT needs to be considered for neck location and CTNNB1 S45F mutation DF. Good results can be obtained by selecting a treatment method that considers the tumor location even in cases that require intervention.
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Affiliation(s)
- Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Rare Cancer Center, Nagoya University Hospital, Nagoya, Japan
| | - Yoshihiro Nishida
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Rare Cancer Center, Nagoya University Hospital, Nagoya, Japan
- Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan
| | - Kan Ito
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Ikuta
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Urakawa
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Koike
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Imagama
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Evola G, Scravaglieri M, Piazzese E, Evola FR, Di Fede GF, Piazza L. Misdiagnosed desmoid fibromatosis of the chest wall presenting in emergency like as recurrence of post-traumatic hematoma: A case report and review of the literature. Int J Surg Case Rep 2022; 94:107019. [PMID: 35439723 PMCID: PMC9026611 DOI: 10.1016/j.ijscr.2022.107019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Desmoid Fibromatosis (DF) represents a rare neoplasm developing from fascial and musculoaponeurotic structures. Preoperative diagnosis of DF is a challenge because of its rarity and nonspecific presentation. Imaging may be helpful for determining the correct diagnosis. Currently there are different clinical treatments of DF including surgical treatment, drug treatment and radiotherapy. Case presentation A 43-year-old Caucasian male presented to the Emergency Department with a 6-month history of recurrence of post-traumatic chest wall hematoma. Physical examination revealed a partially solid, painless mass on the right anterior chest wall. Laboratory tests reported and neutrophilic leukocytosis. Thoracic contrast-enhanced computed tomography showed a smooth contour, heterogeneous and hypodense subcutaneous soft tissue mass anterior to the right pectoral muscles and to the right 4th–7th rib. The patient underwent surgery: a solid suprafascial neoplasm was completely excised. The postoperative course of the patient was uneventful. Clinical discussion DF is a soft tissue neoplasm with a tendency for local invasion and recurrence. The course of DF cannot be predicted, being fatal if DF infiltrates vital structures. Diagnosis of DF is difficult and imaging may be helpful for determining the correct diagnosis. Currently the treatment for DF has shifted from surgery (post-operative recurrence rates of 20%–70%) to conservative therapy including watchful waiting. Conclusion DF is a myofibroblastic proliferative soft tissue tumor and classified as an intermediate malignancy. Preoperative diagnosis of DF needs a high index of suspicion and is facilitated by imaging. Surgery, among different treatments, represents a potentially curative treatment of DF. Desmoid Fibromatosis (DF) represents a rare neoplasm developing from fascial and musculoaponeurotic structures. The central biologic event in the DF formation is an alteration in the Wnt/β-catenin pathway. Diagnosis of DF is a challenge because of the absence of specific clinical presentation, pathognomonic radiographic and laboratory findings. Surgery, among different treatments, represents a potentially curative treatment of DF.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy.
| | - Mario Scravaglieri
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy
| | - Enrico Piazzese
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy
| | - Francesco Roberto Evola
- Department of Orthopedic and Traumatology, Cannizzaro Hospital, via Messina 829, 95126 Catania, Italy
| | - Giovanni Francesco Di Fede
- Department of Diagnostic Radiology, Neuroradiology and Interventional Radiology, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy
| | - Luigi Piazza
- General and Emergency Surgery Department, Garibaldi Hospital, Piazza Santa Maria di Gesù 5, 95124 Catania, Italy
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Penel N, Bonvalot S, Bimbai AM, Meurgey A, Le Loarer F, Salas S, Piperno-Neumann S, Chevreau C, Boudou-Rouquette P, Dubray-Longeras P, Kurtz JE, Guillemet C, Bompas E, Italiano A, Le Cesne A, Orbach D, Thery J, Le Deley MC, Blay JY, Mir O. Lack of prognostic value of CTNNB1 mutation profile in desmoid-type fibromatosis. Clin Cancer Res 2022; 28:4105-4111. [PMID: 35294527 DOI: 10.1158/1078-0432.ccr-21-4235] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/04/2022] [Accepted: 03/14/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE This prospective nationwide cohort study aimed to investigate desmoid-type fibromatosis (DF) outcomes, focusing on the prognostic value of CTNNB1 mutations. EXPERIMENTAL DESIGN ALTITUDES (NCT02867033) was a nationwide prospective cohort study of DF diagnosed between January 2016 and December 2020. At diagnosis, CTNNB1 molecular alterations were identified using next-generation sequencing or Sanger sequencing. The primary endpoint was event-free survival (EFS) (progression, relapse, or death). We enrolled 628 patients managed by active surveillance (AS), surgical resection (SR), or systemic treatment as front-line therapy. RESULTS Overall, 516 (82.2%) patients (368 females [71.3%], median age 40.3 years [range, 1-89]) were eligible for analysis. In 435 (84.3%) cases, there was one CTNNB1 molecular alteration: p.T41A, p.S45F, or p.S45P. The front-line management was AS in 352 (68.2%), SR in 120 (23.3%), and systemic treatments in 44 (8.5%) patients. CTNNB1 mutation distribution was similar across the three therapeutic groups. The median follow-up period was 24.7 (range, 0.4-59.7) months. The estimated 3-year EFS rate was 66.2% (95%CI, 60.5%-71.2%). DF harboring p.S45F was significantly associated with male sex (p=0.03), non-abdominal wall sites (p=0.05), pain (p=0.007), and large tumor size (p=0.025). CTNNB1 p.S45F mutation was not significantly associated with EFS, either in univariate (hazard ratio [HR]=1.06; 95% confidence interval [CI], 0.65-1.73; p=0.81), or in multivariate analysis (HR=0.91; 95% CI, 0.55-1.49; p=0.71). CONCLUSIONS We found that CTNNB1 mutation profile was associated with unfavorable prognostic factors but was not a prognostic factor for EFS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jean-Yves Blay
- Centre Leon Bérard, Univ Claude Bernard, Unicancer, Lyon, France
| | - Olivier Mir
- Gustave Roussy Cancer Institute, Villejuif, France
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Yang T, Liu H, Liao Z, Zhang C, Xiang L, Yang J. Postoperative Adjuvant Radiotherapy Can Delay the Recurrence of Desmoid Tumors After R0 Resection in Certain Subgroups. Front Surg 2021; 8:697793. [PMID: 34589515 PMCID: PMC8473782 DOI: 10.3389/fsurg.2021.697793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background: When patients with desmoid tumors (DTs) present uncontrolled clinical symptoms, surgery is an effective treatment, but the high postoperative recurrence rate is a major problem. The significance of adjuvant radiotherapy has been debated for many years, and the significance of aggressive surgery has not been reported. Methods: Medical records for DT patients were collected. KM analysis and the Mann-Whitney U-test were performed to evaluate the role of radiotherapy and aggressive surgery in the entire cohort and different subgroups. Results: Of 385 DT patients, 267 patients with R0 resection were included in the final analysis. A total of 53 patients (19.85%) experienced recurrence. Although radiotherapy showed no significant effect on recurrence-free survival (RFS) or time to recurrence (TTR) in the entire cohort, radiotherapy delayed recurrence in the age ≤ 30 years old subgroup (TTR = 35 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.014) and the tumor diameter >5 cm subgroup (TTR = 26 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.02) among patients with a single tumor. Aggressive surgery improved RFS in the tumor diameter >5 cm subgroup (p = 0.049) but not the entire cohort. Conclusions: Although radiotherapy cannot improve RFS, it can delay recurrence in the age ≤ 30 years old subgroup and the tumor diameter >5 cm subgroup among patients with a single tumor. For patients with large invasive tumors and multiple involved sites, aggressive surgery could be selected to achieve complete tumor resection to improve RFS.
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Affiliation(s)
- Tielong Yang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer (NCRCC), Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Haotian Liu
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer (NCRCC), Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Zhichao Liao
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer (NCRCC), Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer (NCRCC), Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Lijie Xiang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer (NCRCC), Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
| | - Jilong Yang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China.,National Clinical Research Center for Cancer (NCRCC), Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, Tianjin, China
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Less-invasive fascia-preserving surgery for abdominal wall desmoid. Sci Rep 2021; 11:19379. [PMID: 34588532 PMCID: PMC8481551 DOI: 10.1038/s41598-021-98775-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/15/2021] [Indexed: 12/19/2022] Open
Abstract
The mainstay of treatment for desmoid has been shifted to active surveillance (AS). However, surgery is still being performed on abdominal wall desmoid with a wide surgical margin. The purposes of this study are to clarify the treatment results of less-invasive, fascia preserving surgery for patients with abdominal wall desmoid, and to propose a new treatment modality. Since 2009, 34 patients with abdominal desmoid have been treated in our institution. Among them, as a final treatment modality, 15 (44%) were successful with AS, 15 were subjected to less-invasive surgery, and 4 methotrexate and vinblastine treatment. The clinical results of less-invasive surgery were clarified. In the surgical group, although the surgical margin was all microscopic positive (R1), only one patient (6.7%), who has the S45F mutation type of CTNNB1, showed recurrence, at a mean follow-up of 45 months. There were no patients with familial adenomatous polyposis (FAP)-related desmoid in this cohort. Only two patients (13%) required fascia lata patch reconstruction after removal of the tumor. In patients with non FAP-related abdominal wall desmoid, less-invasive, fascia preserving surgery is recommended as a favorable option as active treatment. Based on the results of this study, multi-institutional further research is warranted with an increased number of patients.
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11
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Abstract
OPINION STATEMENT Desmoid tumors have a variable clinical course that ranges from indolence or spontaneous regression to an aggressive pattern marked by local invasion. Up to half may remain stable or regress; watchful waiting is the preferred approach in the initial management of desmoid tumors. Symptomatic or progressive tumors or those that may affect adjacent critical structures require surgery, radiotherapy, or systemic therapy. Although radiotherapy effectively controls desmoid tumors in most cases, concerns regarding late toxicity exist. Definitive radiotherapy for macroscopic disease is indicated when a non-morbid complete surgical resection cannot be accomplished and provides similar control rates to surgery plus radiotherapy but avoids toxicity from combined-modality treatment (surgery and radiotherapy). Adjuvant radiotherapy can be considered for microscopically involved margins, particularly for recurrent cases or when a future recurrence may be challenging to treat. Large size, extremity site, and younger age are poor prognostic factors after radiotherapy. In the extremity, radiotherapy may have superior outcomes to surgery. Younger patients, especially children, are challenging to manage as they are at particular risk for late toxicity due to the number of potential years at risk. For patients under 20 years old, for whom a non-morbid complete resection is not possible, we recommend systemic therapy as the first line of treatment. Although the long-term efficacy of systemic therapy is unproven, this strategy allows additional time for growth and development prior to radiotherapy. In younger patients and those with axial desmoid tumors adjacent to critical organs, consideration should be given to using proton therapy as the dosimetric advantages may mitigate some of the toxicity associated with conventional radiotherapy.
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12
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Gene expression in urinary incontinence and pelvic organ prolapse: a review of literature. Curr Opin Obstet Gynecol 2020; 32:441-448. [DOI: 10.1097/gco.0000000000000661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Nishida Y, Hamada S, Kawai A, Kunisada T, Ogose A, Matsumoto Y, Ae K, Toguchida J, Ozaki T, Hirakawa A, Motoi T, Sakai T, Kobayashi E, Gokita T, Okamoto T, Matsunobu T, Shimizu K, Koike H. Risk factors of local recurrence after surgery in extraabdominal desmoid-type fibromatosis: A multicenter study in Japan. Cancer Sci 2020; 111:2935-2942. [PMID: 32539220 PMCID: PMC7419055 DOI: 10.1111/cas.14528] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 02/06/2023] Open
Abstract
This study was undertaken to clarify the risk factors, including the mutation status of CTNNB1, for the local recurrence after surgery of the rare disease desmoid‐type fibromatosis. It was designed as a multiinstitutional joint research project with 7 major centers in Japan participating. The committee members of 7 major medical centers specializing in bone and soft tissue tumors formed this study group to develop clinical care guidelines. Of 196 cases with specimens and medical records collected from the 7 institutions, 88 surgically treated ones were analyzed regarding clinicopathologic prognostic factors including CTNNB1 mutation status. Excluding R2 cases (n = 3), 5‐year local recurrence‐free survival (LRFS) was 52.9%. No case had received pre‐ or postoperative radiotherapy. Univariate analysis revealed that extremity location (P < .001) and larger size (8 cm or more, P = .036) were significant adverse risk factors for LRFS. Multivariate analysis indicated that extremity location (P < .001) was a significantly adverse factor in addition to recurrent tumor (P = .041), S45F mutation (P = .028), and R1 surgical margin (P = .039). Preoperative drug treatment, including nonsteroidal antiinflammatory drugs, did not reduce the incidence of local recurrence (P = .199). This is the first study to analyze the factors correlating with outcomes of surgical treatment, including CTNNB1 mutation status, in a relatively large number of cases from an Asian country. Tumor location was found to be the most influential prognostic factor for local recurrence, similar to the results from Europe and North America. The development of more sensitive method(s) for determination of CTNNB1 mutation is a priority for future study.
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Affiliation(s)
- Yoshihiro Nishida
- Department of Rehabilitation Medicine, Nagoya University Hospital, Nagoya, Japan.,Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shunsuke Hamada
- Department of Orthopedic Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akira Kawai
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Toshiyuki Kunisada
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akira Ogose
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | | | - Keisuke Ae
- Department of Orthopedic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - Junya Toguchida
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Toshifumi Ozaki
- Department of Orthopedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akihiro Hirakawa
- Department of Biostatistics and Bioinformatics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toru Motoi
- Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tomohisa Sakai
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eisuke Kobayashi
- Department of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Tabu Gokita
- Department of Orthopedic Surgery, Saitama Cancer Center, Saitama, Japan
| | - Takeshi Okamoto
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoya Matsunobu
- Department of Orthopedic Surgery, Kyushu Rosai Hospital, Fukuoka, Japan
| | - Koki Shimizu
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Koike
- Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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