TY - JOUR
T1 - Desmoid-type fibromatosis and pregnancy
T2 - A multi-institutional analysis of recurrence and obstetric risk
AU - Fiore, Marco
AU - Coppola, Sara
AU - Cannell, Amanda J.
AU - Colombo, Chiara
AU - Bertagnolli, Monica M.
AU - George, Suzanne
AU - Le Cesne, Axel
AU - Gladdy, Rebecca A.
AU - Casali, Paolo G.
AU - Swallow, Carol J.
AU - Gronchi, Alessandro
AU - Bonvalot, Sylvie
AU - Raut, Chandrajit P.
PY - 2014/1/1
Y1 - 2014/1/1
N2 - 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.
AB - 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.
KW - aggressive fibromatosis
KW - desmoid-type fibromatosis
KW - pregnancy
KW - prognosis
KW - wait and see
UR - http://www.scopus.com/inward/record.url?scp=84896876891&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000000224
DO - 10.1097/SLA.0000000000000224
M3 - Article
C2 - 24477160
AN - SCOPUS:84896876891
SN - 0003-4932
VL - 259
SP - 973
EP - 978
JO - Annals of Surgery
JF - Annals of Surgery
IS - 5
ER -