Predictors of behaviour in solitary fibrous tumours of the pleura surgically resected: Analysis of 107 patients

Abstract

Objectives: Gold standard therapy for solitary fibrous tumour of the pleura is complete surgical resection. Aims of this retrospective study are to evaluate oncological and surgical outcomes and to verify the clinical reliability of prognostic scores presented in literature. Methods: Study population: 107 patients surgically treated between 1972 and 2018. Male/female ratio: 1/2.45; median age at surgery: 60 years (range, 19-80); peduncle lesions 69.8%; visceral pleura origin 72.9%; benign histology 73.8%; median diameter 8 cm (range 1 to 35, 27 cases giant [≥15 cm]).Results: After a median follow up of 7 years, 12 patients had recurrence. By multivariate analysis, malignant histology (P = .03; HR, 4.17; 95% CI, 1.15-15.06), origin from parietal pleura (P = .03; HR, 3.90; 95% CI, 1.08-14.09), England (P = .002; HR, 1.98; 95% CI, 1.28-3.07), Diebold (P = .008; HR, 1.96; 95% CI, 1.20-3.22) and Tapias (P = .003; HR, 1.75; 95% CI, 1.20-2.53) scores were found independent significant predictors of relapse. Giant tumours were associated with open surgery (P = .003), origin from parietal pleura (P = .011) and intraoperative bleeding (P > .001).Overall 10-year disease-free survival (DFS) rate was 81%. Predictors of worst DFS were parietal pleura origin (P = .002), malignant histology (P = .006) and all the prognostic scores.Conclusions: Malignant histology and origin from parietal pleura were significant predictors of tumour recurrence and worst DFS. The use of current scoring systems can help to predict clinical behaviour. Patients with higher risk of relapse can benefit from closer follow up, prolonged over 10 years. K E Y W O R D S fibroma, prognostic factors, prognostic scores, recurrence, solitary fibrous tumour Abbreviations: CT, computed tomography; DFS, disease free survival; FDG, fluorodeoxyglucose; HPF, high-power fields; PET-CT, positron emission tomography-CT; SCLC, small cell lung cancer; SFTP, solitary fibrous tumour of the pleura; SFTPs, solitary fibrous tumours of the pleura.Alice Bellini and Giuseppe Marulli equally contributed to the major design, planning and writing of the paper.

Surgery for Solitary Fibrous Tumors of the Pleura: A Review of the Available Evidence

“…A recent meta-analysis published in 202 based on 23 retrospective studies [92] found a 9% recurrence rate after surgery (even in case of R0 resections); the recurrence rate was significantly different according to the pathological features of the pSFT (benign and malignant: 3% and 22% recurrence rate, respectively); nevertheless, no significant difference was seen according to the site of origin of the tumor (visceral or parietal pleura). The impact of malignant histology on DFS has been confirmed by several authors [25,27,63,93,94]. On the other hand, Bellini and her colleagues [25] found a significantly worse DFS in patients who had a pSFT arising from parietal pleura.…”

“…The impact of malignant histology on DFS has been confirmed by several authors [25,27,63,93,94]. On the other hand, Bellini and her colleagues [25] found a significantly worse DFS in patients who had a pSFT arising from parietal pleura. Moreover, in a multi-centric international study, Ghanim focused on circulating biomarkers as prognostic factors; the authors found that higher levels of fibrinogen were related with a significantly lower DFS, while the neutrophil-lymphocyte ratio (NLR) had no influence on DFS.…”

Risk factors for recurrent disease after resection of solitary fibrous tumor: a systematic review

“…Number of mitosis [≥4 mitosis/high-power fields (HPFs)] has traditionally been a central criteria in the distinction between malignant and benign SFT ( 4 ). Indeed, mitotic index seems to be higher in malignant SFT, and it is found to be prognostic for recurrence or metastasis regardless the anatomic location ( 3 , 5 – 8 , 10 – 12 , 14 , 17 , 22 , 23 , 25 , 26 , 29 , 32 , 36 , 37 , 39 – 42 , 44 – 52 ).…”

Hipoglucemia en paciente sin diabetes

“…En el England Score el TFSP fue clasificado como maligno con uno o más de los siguientes criterios: mitosis > 4/10 HPF, presencia de necrosis, presencia de atipia nuclear e hipercelularidad. La escala Diebold (con un rango de 0 a 4) consideró el número de mitosis, tamaño del tumor, presencia de Ki-67 y presencia de necrosis como criterios de malignidad, mientras que la escala Tapias (con rango de 0 a 6) incluyó el origen pleural, la morfología, tamaño del tumor, presencia de hipercelularidad, presencia de necrosis o hemorragia y número de mitosis 9 . Las conclusiones del estudio indicaron que la histología maligna y el origen en la pleura parietal fueron predictores significativos de la recurrencia tumoral y de peor supervivencia libre de enfermedad.…”