Harzem ÖZGER, Levent ERALP, Berkin TOKER, Fulya AĞAOĞLU, Yavuz DİZDAR

Ekstra-abdominal desmoid tümörlerde nüks ve hastalıksız sağkalımı etkileyen prognostik faktörlerin değerlendirilmesi

Amaç: Tek başına cerrahi veya cerrahiyle beraber radyoterapi ile tedavi edilen primer ya da nüks ekstra-abdominal desmoid tümörlü hastalarda tedavi sonuçları ve prognostik faktörler araştırıldı. Çalışma planı: Çalışmaya, ekstra-abdominal desmoid tümör nedeniyle tedavi edilen 38 hasta (23 kadın, 15 erkek; ort. yaş 24; dağılım 5-61) alındı. Bu hastaların sekizi (%21.1) daha önceki cerrahi sonrasında nüks gelişen olgulardı. Tümörlerin 12’si (%31.6) üst ekstremitede, 22’si (%57.9) alt ekstremitede, dördü (%10.5) aksiyel bölgede görüldü. Primer cerrahi rezeksiyon sonrasında 22 hastaya radyoterapi uygulandı. Sağkalım analizi için Kaplan-Meier yöntemi kullanıldı. Hastalar ortalama 7.3 yıl (dağılım 2.5-228 ay) takip edildi. Sonuçlar: Tedaviden sonra 20 hastada (%52.6) nüks gelişti. Bu hastaların altısında tedavi başlangıcında da nüks vardı. Nüks gelişen 20 hastanın 11’i (%55) adjuvan radyoterapi görmüştü. Nüksler, üç hastada ilk radyoterapi bölgesinin dışında, sekiz hastada daha önce radyoterapi uygulanmış bölgede görüldü. Ortalama hastalıksız sağkalım 38±8 ay, sekiz yıllık hastalıksız sağkalım %35.7±8.5 bulundu. Ortalama hastalıksız sağkalım adjuvan radyoterapi gören (47.9±7.9 ay) ve görmeyen olgular (37.9±12.4 ay) arasında ve rezeksiyon bölgesinde nüks gelişen olgular (12.1±4.7 ay) ile farklı bölgede nüks gelişen olgular (24.3±1.0 ay) arasında anlamlı farklılık göstermedi (p>0.05). Cinsiyet, yaş, yerleşim, sınır durumu ya da radyoterapi gibi potansiyel prognostik faktörlerin hiçbiri hastalıksız sağkalım üzerinde etkili bulunmadı. Çıkarımlar: Çalışmamızda yüksek nüks oranı ile ilişkili olabilecek herhangi bir prognostik faktör tanımlanamadı.

Anahtar Kelimeler:

Hastalıksız sağkalım, Değerlendirme çalışmaları, Fibromatoz, agresif, Seyir, Neoplazm nüksü, lokal

Evaluation of prognostic factors affecting recurrences and disease-free survival in extra-abdominal desmoid tumors

Objectives: We investigated treatment results and the role of potential prognostic factors in patients treated by surgery with or without adjuvant radiotherapy for primary or recurrent extra-abdominal desmoid tumors. Methods: The study included 38 patients (23 females, 15 males; mean age 24 years; range 5 to 61 years) who underwent surgical treatment for extra-abdominal desmoid tumors. Of these, eight patients (21.1%) already had recurrences before treatment. Involvement was in the upper extremity in 12 cases (31.6%), in the lower extremity in 22 cases (57.9%), and in the axial region in four cases (10.5%). Twenty-two patients received adjuvant radiotherapy following surgical resection. Survival was analyzed by the Kaplan-Meier method. The mean follow-up period was 7.3 years (2.5 to 228 months). Results: Twenty patients (52.6%) developed recurrences after treatment. Of these, recurrences were already present in six patients, and adjuvant radiotherapy was administered to 11 patients (55%). Recurrences developed at the irradiated site in eight patients, and in other regions in three patients. The mean disease-free survival was 38±8 months, and eightyear disease-free survival was 35.7±8.5%. Disease-free survival did not differ significantly between patients receiving adjuvant radiotherapy (47.9±7.9 months) and those treated with surgery alone (37.9±12.4 months), and between patients who developed a recurrence at the resection site (12.1±4.7 months) or at a different site (24.3±1.0 months) (p>0.05). None of the potential prognostic factors including gender, age, localization, surgical margin, or adjuvant irradiation were found to affect disease-free survival. Conclusion: In our series, no prognostic factor could be identified as having an association with the high recurrence rate.

Keywords:

Disease-Free Survival, Evaluation Studies, Fibromatosis, Aggressive, Prognosis, Neoplasm Recurrence, Local,

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