Clinicopathological Characteristics and Prognostic Factors for the Recurrence of Abdominal Desmoid Tumors: A Retrospective Study of 113 Patients from Two Chinese Hospitals

Clinicopathological Characteristics and Prognostic Factors for the Recurrence of Abdominal Desmoid Tumors: A Retrospective Study of 113 Patients from Two Chinese Hospitals

Desmoid tumors (DTs) are rare, locally aggressive neoplasms that arise from deep soft tissues. Although they do not metastasize, their propensity for local recurrence and invasion into surrounding structures can lead to significant morbidity and functional impairment. Abdominal desmoid tumors (ADTs), which include tumors of the abdominal wall and intra-abdominal cavity, are a subset of DTs that exhibit distinct biological behaviors and clinical outcomes. This study aimed to delineate the clinicopathological characteristics of ADTs and identify prognostic factors for recurrence-free survival (RFS) following surgical resection.

The study retrospectively reviewed 343 patients who underwent surgical resection for DTs at two Chinese institutions between January 2000 and January 2019. After applying inclusion criteria—patients with ADTs, macroscopically complete surgical resection (R0 or R1), and surgical resection as the initial treatment—113 patients were included in the analysis. The study protocol was approved by the Ethics Committee of the National Cancer Center, and all patients provided informed consent.

The cohort was predominantly female (73.5%, n = 83), with a median age of 36 years (range: 15–71 years). Patients were categorized into two groups based on tumor location: abdominal wall (n = 66) and intra-abdominal cavity (n = 47). Significant differences were observed between the two groups. The abdominal wall group had a higher proportion of female patients (93.9% vs. 44.7%, P < 0.001) and a history of cesarean section (34.8% vs. 6.4%, P 10 cm in 27.7% vs. 7.6%, P = 0.011). Additionally, intra-abdominal tumors were more likely to adhere to important nerves or vasculature (42.6% vs. 13.6%, P = 0.001) and present with clinical symptoms (40.4% vs. 13.6%, P = 0.001).

Surgical outcomes also differed between the two groups. The abdominal wall group had significantly shorter operation times (98.7 ± 50.0 vs. 194.5 ± 90.3 minutes, P < 0.001) and lower intraoperative blood loss (24.1 ± 41.1 ml vs. 136.0 ± 149.4 ml, P < 0.001). All patients underwent macroscopically complete surgical resection, and there were no perioperative deaths.

The median follow-up interval was 61 months (range: 9–250 months). During this period, 12 patients experienced recurrence: 2 in the intra-abdominal group and 10 in the abdominal wall group. The estimated 5- and 10-year RFS rates for the entire cohort were 92.8% and 89.8%, respectively. Notably, one patient experienced recurrence beyond 10 years. None of the 12 patients with recurrent disease experienced further recurrence after surgical resection with or without adjuvant radiotherapy.

Univariate analysis identified tumor location, tumor size, and margin status as significant predictors of RFS (P 10 cm, and R1 margins had higher recurrence rates. Multivariate analysis confirmed these factors as independent prognostic indicators. Tumor location (hazard ratio [HR]: 8.407; 95% confidence interval [CI]: 1.649–42.865; P = 0.010), tumor size (HR: 17.437; 95% CI: 3.648–83.346; P < 0.001), and margin status (HR: 8.045; 95% CI: 2.388–27.099; P = 0.001) significantly influenced RFS.

The study highlighted the distinct clinicopathological features and prognostic outcomes of abdominal wall and intra-abdominal DTs. Abdominal wall DTs were more common in young women with a history of cesarean section, while intra-abdominal DTs were larger and more likely to present with clinical symptoms. The latter group also had a higher recurrence rate, likely due to the difficulty in achieving radical resection and the tumors’ proximity to critical structures.

In conclusion, ADTs exhibit unique clinicopathological characteristics based on their location. Abdominal wall DTs are associated with better prognosis, while intra-abdominal DTs pose greater challenges due to their size, adherence to vital structures, and higher recurrence rates. Achieving R0 resection and maintaining tumor size <5 cm are critical for improving RFS in ADT patients. These findings underscore the importance of tailored surgical strategies and close follow-up to optimize outcomes for patients with ADTs.

doi.org/10.1097/CM9.0000000000001333

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