Desmoid-type fibromatosis and pregnancy: a multi-institutional analysis of recurrence and obstetric risk.

Autor:	Fiore M; Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy †Department of Surgery, Institut Gustave Roussy, Villejuif, France ‡Division of General Surgery, Mount Sinai Hospital; Department of Surgical Oncology, Princess Margaret Hospital; and Department of Surgery, University of Toronto, Toronto, Ontario, Canada §Department of Surgery, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA ¶Department of Medical Oncology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA ‖Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France **Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy., Coppola S, Cannell AJ, Colombo C, Bertagnolli MM, George S, Le Cesne A, Gladdy RA, Casali PG, Swallow CJ, Gronchi A, Bonvalot S, Raut CP
Jazyk:	angličtina
Zdroj:	Annals of surgery [Ann Surg] 2014 May; Vol. 259 (5), pp. 973-8.
DOI:	10.1097/SLA.0000000000000224
Abstrakt:	Background: Many women who present with desmoid-type fibromatosis (DF) have had a recent pregnancy. Long-term data about disease behavior during and after pregnancy are lacking. Objective: To investigate the possible relationship between DF and pregnancy. Patients and Methods: A cohort of women with DF and pregnancy was identified from 4 sarcoma centers. Four groups were identified: diagnosis during pregnancy (A); diagnosis after delivery (B); DF clinically evident during pregnancy (C); and DF resected before pregnancy (D). Progression/regression rates, recurrence rates after resection, and obstetric outcomes were analyzed. Results: Ninety-two women were included. Forty-four women (48%) had pregnancy-related DF (A + B), whereas 48 (52%) had a history of DF before conception (C + D). Initial treatment was resection in 52%, medical therapy in 4%, and watchful waiting in 43%. Postsurgical relapse rate in A + B was 13%, although progression during watchful waiting was 63%. Relapse/progression in C + D was 42%. After pregnancy, 46% underwent treatment of DF, whereas 54% were managed with watchful waiting. Eventually, only 17% experienced further progression after treatment. Spontaneous regression occurred in 14%. After further pregnancies, only 27% progressed. The only related obstetric event was a cesarean delivery. Conclusions: Pregnancy-related DF has good outcomes. Progression risk during pregnancy is high, but it can be safely managed. DF does not increase obstetric risk, and it should not be a contraindication to future pregnancy.
Databáze:	MEDLINE
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