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The Desmoid Tumor Research Foundation

March 2023

Pain in desmoid-type fibromatosis: Prevalence, determinants and prognosis value

Author Information

Penel N (1, 2), Bonvalot S (3), Le Deley MC (4, 5), Italiano A (6), Tlemsani C (7), Pannier D (1), Leguillette C (5), Kurtz JE (8), Toulmonde M (6), Thery J (5), Orbach D (9), Dubray-Longeras P (10), Verret B (11), Bertucci F (12), Guillemet C (13), Laroche L (14), Dufresne A (15), Blay JY (15), Le Cesne A (11).

(1) Department of Medical Oncology, Centre Oscar Lambret, Lille, France, (2) University of Lille, CHU Lille, ULR 2694-Metrics: Evaluation des Technologies de Santé et des Pratiques Médicales, Lille, France, (3) Department of Surgical Oncology, Institut Curie, Université Paris Sciences et Lettres, Paris, France, (4) CESP, INSERM, Paris-Saclay University, Paris-Sud University, UVSQ, Villejuif, France, (5) Clinical Research Department, Centre Oscar Lambret, Lille, France, (6) Department of Medical Oncology, Institut Bergonié, Bordeaux, France, (7) Department of Medical Oncology, APHP Centre Hôpital Cochin, Université Paris Cité, Paris, France, (8) Department of Medical Oncology, Strasbourg University Hospital, Strasbourg, France, (9) SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with Cancer), PSL Research University, Institut Curie, Paris, France, (10) Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France, (11) Medical Oncology Department, Gustave Roussy, Villejuif, France, (12) Medical Oncology Department, Institut Paoli Calmette, Marseille, France, (13) Department of Medical Oncology, Centre Henri Becquerel, Rouen, France, (14) Labelled North-West DataCenter, Centre Henri Becquerel, Rouen, France, (15) Department of Medical Oncology, Centre Léon Bérard, Lyon, France.

Publication

Int J Cancer

Summary

The aim of this study is to evaluate the prevalence, determinants and prognostic value of pain at diagnosis in patients with desmoid-type fibromatosis (DF). We selected patients from the ALTITUDES cohort (NCT02867033), managed by surgery, active surveillance or systemic treatments, with pain assessment at diagnosis. Patients were invited to fill QLQ-C30 questionnaire and Hospital Anxiety Depression Scale. Determinants were identified using logistic models. Prognostic value on event-free survival (EFS) was evaluated using the Cox model. Overall, 382 patients were included in the current study (median age: 40.2 years; 117 men). The prevalence of pain was 36%, without significant difference according to first-line treatment (P = .18). In the multivariate analysis, pain was significantly associated with tumor size >50 mm (P = .013) and tumor site (P < .001); pain was more frequent in the neck and shoulder locations (odds ratio: 3.05 [1.27-7.29]). Pain at baseline was significantly associated with poor quality of life (P < .001), depression (P = .02), lower performance status (P = .03) and functional impairment (P = .001); we also observed a nonsignificant association with anxiety (P = .10). In the univariate analysis, baseline pain was associated with poor EFS; the 3-year EFS was 54% in patients with pain compared to 72% in those without pain. After adjustment for sex, age, size and line of treatment, pain was still associated with poor EFS (hazard ratio: 1.82 [1.23-2.68], P = .003). One third of recently diagnosed patients with DF experienced pain, especially those with larger tumors and neck/shoulder locations. Pain was associated with unfavorable EFS after adjustment for the confounders.

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