老年侵袭性纤维瘤的临床特征与外科治疗

目的探讨60岁以上老年侵袭性纤维瘤(AF)患者的临床特征、手术疗效及生存预后。方法回顾性分析中国医学科学院北京协和医学院肿瘤医院2008年1月至2019年1月收治的22例老年AF患者的临床病理资料。结果22例患者中男10例,女12例;年龄60～80岁,平均年龄649岁。腹内型AF 6例,肿瘤均位于小肠系膜;腹壁型AF 1例;腹外型AF 15例,其中肿瘤位于胸壁4例,肩背臀部5例,头颈部6例。平均肿瘤直径为55 cm。切缘阳性者4例,分别位于头颈部2例、臀部1例、胸壁1例,其中3例患者术后行化疗／放疗。全组中位随访时间为37个月,共4例患者在我院手术后复发,均为腹外型AF。其中,复治者3例,切缘阳性者2例。中位复发时间为25个月,随访期间1例患者死于肿瘤复发。结论老年AF患者通过根治性手术切除可获得令人满意的治疗效果。初次手术疗效对老年AF患者至关重要,在尽可能保留器官组织功能的前提下确保足够手术切除范围。对于无法达到R0切除的患者,应考虑术后辅助治疗以控制局部复发。

Clinical features and surgical treatment of aggressive fibromatosis in the elderly

Objective To investigate the clinical features, surgical efficacy and survival prognosis of elderly patients with aggressive fibromatosis (AF) over 60 years old. Methods The clinical and pathological data of 22 elderly patients with AF admitted to Cancer Hospital Chinese Academy of Medical Sciences from January 2008 to January 2019 were retrospectively analyzed. Results Of the 22 patients, 10 were male and 12 were female; The age range was 60 to 80 years, with an average age of 64.9 years. There were 6 cases of intra-abdominal AF (27.3%), all of which were located in the small intestinal mesentery; One patient with abdominal wall AF (4.5%); There were 15 cases (68.2%) of extra-abdominal AF, including 4 cases with tumor located in chest wall, 5 cases with tumor in shoulder, back and hip, and 6 cases with tumor in head and neck, among which 3 cases received chemotherapy and radiotherapy after surgery. The median follow-up time of the whole group was 37 months, and a total of 4 patients recurred after surgery in our hospital, all of whom were extra-abdominal AF. Of the 4 patients with recurrence, 2 had positive surgical margin. The median recurrence time was 25 months, and one patient died of tumor recurrence during follow-up. Conclusion In the elderly AF patients, radical surgical resection can achieve a satisfactory therapeutic effect. In addition, the efficacy of primary surgery is crucial for the elderly patients with AF, ensuring adequate surgical resection scope on the premise of preserving organ and tissue functions as far as possible. For patients unable to achieve R0 resection, postoperative adjuvant therapy should be considered to control local recurrence.