An analysis of the treatment and prognostic factors of desmoid tumors of the extremities and trunk

ZHANG Xin-xin; XU Li-bin; ZHAO Zhen-guo; LIU Ting; YUAN Zhen-nan; YU Sheng-ji

doi:10.3969/j.issn.2095-252X.2015.01.007

Abstract：Objective To analyze the clinical characteristics and prognostic factors of desmoid tumors of the extremities and trunk, and to provide the basis for clinical treatment and prognostic evaluation.Methods Clinical data of 72 patients with desmoid tumors of the extremities and trunk who were adopted and followed up from January 1999 to September 2014 were retrospectively reviewed. The clinical characteristics, treatment approaches, postoperative recurrence and other related data were summarized. The factors related to recurrence were recorded, including gender, age, tumor site, tumor size, surgical margin, primary or recurrent tumor, radiotherapy and chemotherapy.Results No death occurred, and the 5-year overall survival rate was 100%. All the 72 patients were followed up from 2 to 184 months, and the median follow-up time was 96 months. The 2-year recurrence rate was 13.9%, and the 5-year recurrence rate was 20.8%. Prognostic factors associated to the 2-year recurrence rate included surgical margin and with or without radiotherapy. The 2-year recurrence rate after R1 resection was higher than that after R0 resection (P<0.05 ). The 2-year recurrence rate in the patients who did not receive radiotherapy was higher than that in the patients who received radiotherapy during and after the surgery (P<0.05 ). Prognostic factors associated to the 5-year recurrence rate factors included tumor site, tumor size, surgical margin and with or without radiotherapy. The 5-year recurrence rate with the tumor size more than 5 cm was obviously higher than that with the tumor size less than or equal to 5cm (P<0.05 ). The 5-year recurrence rate in the patients with desmoid tumors of the extremities was obviously higher than that in the patients with desmoid tumors of the trunk (P<0.05 ). The 5-year recurrence rate after R1 resection was obviously higher than that after R0 resection (P<0.05 ). The 5-year recurrence rate in the patients who did not receive radiotherapy was obviously higher than that in the patients who received radiotherapy during and after the surgery (P<0.05 ). Multivariate analysis revealed that tumor size was an independent risk factor for recurrence [ relative risk (RR )=5.541,P=0.040 ].Conclusions Recurrence of desmoid tumors of the extremities and trunk is related to tumor size, tumor site, surgical margin and radiotherapy. Tumor size is the independent risk factor for the recurrence of desmoid tumors of the extremities and trunk. In order to reduce the recurrence rate, R0 resection is recommended. Radiotherapy is a better choice for desmoid tumors with the tumor size more than 5 cm, so as to obtain better outcomes. Based on this, when the surgical margin is positive, the indications of adjuvant radiotherapy is more explicit.