• Langue : Français
• Discipline : Médecine. Oncologie
• Identifiant : 2021LILUM372
• Type de thèse : Doctorat de médecine
• Date de soutenance : 28/09/2021

Résumé en langue originale

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Résumé traduit

Background: DF is a locally aggressive tumor with unpredictable course, but most relapses/progressions occur within 2 years. Some indirect arguments suggest that DF could be a hormone-dependent tumor, and that recent exposure to hormonal contraception or pregnancy could influence DF outcome. Methods : ALTITUDES (NCT02867033) is a nationwide cohort of incident DF, diagnosed from January 2016 to February 2021 and confirmed by central pathological review (Penel, ASCO 2021). In the present study, we have selected women with childbearing age. The primary endpoint was event-free survival EFS (including progression during active surveillance -AS -or relapse after surgery -SUR-). We estimated EFS Kaplan-Meier curves and modeled the risk in Cox models. We considered hormonal contraception or pregnancy within the 2 years before DF.Results: We included 242 pts with a median age of 34.7 (range, 18-46.3). Abdominal wall is the most common tumor site (N=124, 51.5%). Pts were managed by AS (N=193) or SUR (N=49). Pregnancy occurred within 2 years before DF diagnosis, at the time of DF diagnosis and after DF diagnosis in 87 (36.0%), 12 (5.0%) and 24 cases (9.9%), respectively. Exposure to hormonal contraception within 2 years before diagnosis, at the time of diagnosis and after diagnosis concerned 107 (44.2%), 82 (33.9%) and 94 cases (38.8%). The median follow-up was 23.9 mo. (range, 0.4 to 59.7 mo.). The 2-year EFS rate was 75.2% (95%CI, 68.3-80.8%). The time-dependent covariates and multivariate analysis shows that recent history of pregnancy significantly alter EFS. The hazard ratio was 2.1 and the p-value 0.017. We observed an increase in risk of event associated with recent pregnancy appeared smaller in patients with an abdominal wall DF than in patients with a tumor from another site (p=0.06). We did not observe any association between exposure to hormonal contraception within 2 years and EFS. Conclusion: Exposure to hormonal contraception did not influence DF outcome. Recent pregnancy doubles the risk of progression/ relapse in newly diagnosed DF.