胸膜孤立性纤维瘤切除后复发的风险因素分析：33 年的经验及评分系统的建立。
Risk factor analysis for the recurrence of resected solitary fibrous tumours of the pleura: a 33-year experience and proposal for a scoring system.
机构信息
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
出版信息
Eur J Cardiothorac Surg. 2013 Jul;44(1):111-7. doi: 10.1093/ejcts/ezs629. Epub 2012 Dec 11.
OBJECTIVES
Surveillance after resection of solitary fibrous tumours of the pleura (SFTP) remains undefined. This study reviews our experience with surgical treatment of SFTP to determine the specific risk factors to predict recurrence.
METHODS
A retrospective review of 59 patients surgically treated for SFTP during the years 1977-2010 was conducted. Clinico-pathological factors for recurrence were analysed by Kaplan-Meier and Cox proportional hazard methods.
RESULTS
The mean age was 57 ± 14 years. There were 32 (54%) men. Among 32 (54%) symptomatic patients, chest pain (22%), cough (19%) and dyspnoea (17%) were most frequent. The mean tumour size was 7.3 ± 6.7 cm, and 14 patients had SFTPs larger than 10 cm. An SFTP was pedunculated in 38 (67%) cases and had a visceral origin in 40 (68%). Paraneoplastic syndromes were observed in 3 (5%) patients. On histopathologic analysis, 4 (7%) presented ≥ 4 mitosis/10 high-power fields (HPFs), 8 (15%) atypia, 14 (24%) hypercellularity and 6 (10%) necrosis. After a mean follow-up of 8.8 ± 7.0 years, we observed 8 (14%) recurrences; median time to recurrence was 6 years (range 2-16 years). Two (3%) patients received adjuvant therapy. We constructed a predictive score for recurrence by assigning one point to each of the six variables: parietal (vs visceral) pleural origin, sessile (vs pedunculated) morphology, size >10 cm (vs <10 cm), the presence of hypercellularity, necrosis and mitotic activity ≥ 4/HPF (vs <4). A score of ≥ 3 best predicted recurrence (sensitivity: 100%, specificity: 92%, area under receiver operating characteristic curve = 0.966, P < 0.0001). With a score of ≥ 3, recurrence-free survival was 80%, 69, 23 and 23% at 3, 5, 10 and 15 years, whereas a score of <3 was 100% up to 15 years. Our scoring system was superior in predicting malignant behaviour and recurrence compared with England's criteria or de Perrot staging.
CONCLUSIONS
The proposed scoring system is simple, easily obtained from existing pathological description and reliably predicts recurrence in this patient population harbouring SFTP. The SFTP score may stratify patient risk and guide postoperative surveillance. We recommend validation in additional clinical series.
目的
胸膜孤立性纤维瘤（SFTP）切除后的监测仍未确定。本研究回顾性分析了我们在 SFTP 手术治疗中的经验，以确定具体的复发预测危险因素。
方法
对 1977 年至 2010 年间接受手术治疗的 59 例 SFTP 患者进行回顾性分析。采用 Kaplan-Meier 和 Cox 比例风险方法分析与复发相关的临床病理因素。
结果
平均年龄为 57 ± 14 岁，其中 32 例（54%）为男性。在 32 例（54%）有症状的患者中，胸痛（22%）、咳嗽（19%）和呼吸困难（17%）最为常见。肿瘤平均大小为 7.3 ± 6.7cm，14 例肿瘤大于 10cm。38 例（67%）为蒂状，40 例（68%）起源于内脏胸膜。3 例（5%）患者出现副瘤综合征。组织病理学分析显示，4 例（7%）有≥4 个/10 高倍视野（HPF）的有丝分裂，8 例（15%）有异型性，14 例（24%）细胞丰富，6 例（10%）有坏死。中位随访 8.8 ± 7.0 年后，我们观察到 8 例（14%）复发；复发中位时间为 6 年（范围 2-16 年）。2 例（3%）患者接受辅助治疗。我们通过为以下 6 个变量中的每个变量分配 1 分，构建了一个复发预测评分：壁层（vs 内脏）胸膜起源、息肉状（vs 蒂状）形态、直径＞10cm（vs＜10cm）、细胞丰富、坏死和有丝分裂活动≥4/HPF（vs＜4）。评分≥3 最佳预测复发（敏感性：100%，特异性：92%，接受者操作特征曲线下面积=0.966，P＜0.0001）。评分≥3 时，3、5、10 和 15 年无复发生存率分别为 80%、69%、23%和 23%，而评分＜3 时，15 年内无复发生存率为 100%。与 England 标准或 de Perrot 分期相比，我们的评分系统在预测恶性行为和复发方面更具优势。
结论
该评分系统简单，易于从现有的病理描述中获得，并能可靠地预测该患者人群中 SFTP 的复发。SFTP 评分可以对患者的风险进行分层，并指导术后监测。我们建议在更多的临床系列中进行验证。
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