Desmoid-type fibromatosis and pregnancy: a multi-institutional analysis of recurrence and obstetric risk

Ann Surg. 2014 May;259(5):973-8. doi: 10.1097/SLA.0000000000000224.

Abstract

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.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Delivery, Obstetric / statistics & numerical data*
  • Female
  • Fibromatosis, Aggressive / diagnosis
  • Fibromatosis, Aggressive / surgery*
  • Follow-Up Studies
  • Humans
  • Incidence
  • Italy / epidemiology
  • Middle Aged
  • Neoplasm Recurrence, Local / diagnosis
  • Neoplasm Recurrence, Local / epidemiology*
  • Pregnancy
  • Pregnancy Complications, Neoplastic*
  • Pregnancy Outcome
  • Prognosis
  • Prospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Young Adult