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DOI: 10.1055/a-1948-2239
Die Aggressive Fibromatose. Eine retrospektive Analyse von 110 Patienten
Aggressive Fibromatosis: Retrospective Analysis of 110 Patients
Zusammenfassung
Die aggressive Fibromatose, histologisch aufgrund der ausbleibenden Metastasierung als benigne klassifiziert, ist charakterisiert durch ein lokal invasives und destruierendes Wachstum mit hohen Rezidivraten nach der Resektion. Aus diesem Grund sind prognostische Rezidivfaktoren, insbesondere das Ausmaß der Resektion viel diskutiert und Therapieentscheidungen herausfordernd für interdisziplinäre Tumorkonferenzen. Zwischen den Jahren 2000–2020 wurden 110 Patienten mit einer aggressiven Fibromatose der Extremitäten oder des Körperstamms am BG Universitätsklinikum Bergmannsheil Bochum chirurgisch behandelt. Zur Aufdeckung potenzieller Prognosefaktoren für die lokale Kontrolle wurden univariate Analysen durchgeführt. Die mediane Nachbeobachtungszeit war 5,9 Jahre. Insgesamt entwickelten 57 (51,8%) der nachuntersuchten Patienten in diesem Zeitraum ein Rezidiv. Das rezidivfreie 5-Jahresüberleben lag in der gesamten Kohorte bei 52,9% (95%-KI: 42,4–62,3). Bei R0-resezierten Patienten war das rezidivfreie Überleben (RFÜ) nach 5 Jahren mit 69,2% im Vergleich zu Patienten mit R1- oder R2 resezierten Tumoren (32,6%) signifikant besser (P<0,001). Darüber hinaus konnten keine weiteren signifikanten Einflussfaktoren ausgemacht werden. Die Ergebnisse der vorliegenden Studie zeigen, dass eine R0-Resektion bzw. eine R0-Resektabilität des Primärtumors mit einer signifikant besseren lokalen Kontrolle assoziiert ist. Die Therapieempfehlung zur Resektion sollte hierbei durch ein interdisziplinäres Tumorboard individuell nach Prüfung der Tumorprogression, möglicher Therapiealternativen und absehbarer Funktionsbeeinträchtigungen getroffen werden.
Abstract
Aggressive fibromatosis, histologically classified as benign due to the absence of metastasis, is characterised by locally invasive and destructive growth with high recurrence rates after resection. For this reason, prognostic recurrence factors, in particular the extent of resection, are much debated, and treatment decisions seem challenging for interdisciplinary tumour conferences. Between the years 2000 and 2020, 110 patients with aggressive fibromatosis of the extremities or trunk received surgical treatment at BG University Hospital Bergmannsheil (Bochum, Germany). Univariate analyses were performed to detect any potential prognosis factors. The median follow-up time was 5.9 years. A total of 57 (51.8%) of these patients developed recurrence during this period. The 5-year recurrence-free survival was 52.9% (95% CI: 42.4–62.3) in the entire cohort. In R0-resected patients, the 5-year recurrence-free survival (RFS) was significantly better (p<0.001) at 69.2% compared with patients with R1 or R2-resected tumours (32.6%). Beyond that, no other significant influencing factors were identified. The results of this study indicate that R0 resection or R0 resectability were associated with a significantly better local control. The therapeutic recommendation for resection should be made individually by an interdisciplinary tumour board in due consideration of tumour progression, possible therapeutic alternatives, and foreseeable functional impairment.
Publication History
Received: 14 July 2022
Accepted: 30 August 2022
Article published online:
09 February 2023
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