Tapias Luis F, Mercier Olaf, Ghigna Maria R, Lahon Benoit, Lee Hang, Mathisen Douglas J, Dartevelle Philippe, Lanuti Michael
Division of Thoracic Surgery, Biostatistics Center, Massachusetts General Hospital, Boston, MA.
The Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation Marie Lannelongue Hospital, Paris, France.
Chest. 2015 Jan;147(1):216-223. doi: 10.1378/chest.14-1180.
Solitary fibrous tumors of the pleura (SFTPs) are infrequent neoplasms with no standardized criteria to predict risk of recurrence after curative surgery. The aim of the present study is to validate a recently proposed recurrence score in a large European cohort of patients with SFTP.
Validation of a previously published scoring system was assessed in a population of 113 patients who underwent complete resection of SFTPs. Patients were scored according to the pleural origin, morphology, size, hypercellularity, presence of necrosis or hemorrhage, and number of mitoses in their SFTPs. Receiver operating characteristic curves were plotted for the score. Time to recurrence analysis was performed using the Kaplan-Meier and Cox proportional hazards methods.
After a mean follow-up of 13.2 ± 7.3 years, there were nine recurrences (8.0%). Score performance to predict recurrence was as follows: sensitivity = 78%, specificity = 74%, positive likelihood ratio = 3.0, and negative likelihood ratio = 0.3. A cutoff of 3 points was used to classify 79 patients (69.9%) at low risk and 34 patients (30.1%) at high risk for recurrence. A high-risk classification was significantly associated with more recurrences during follow-up (P = .004), worse overall survival (P = .0008), more extensive lung resections (P = .001), and the use of adjuvant therapies (P = .009). The present score outperformed England's criteria (P = .049) and de Perrot classification (P < .001) when predicting SFTP recurrence.
The proposed scoring system, which combines common clinical and histologic features of resected SFTPs, remains predictive of recurrence in a separate patient population. The simple score may guide the postoperative surveillance of this uncommon tumor.
胸膜孤立性纤维瘤（SFTPs）是一种罕见肿瘤，目前尚无标准化标准来预测根治性手术后的复发风险。本研究的目的是在一个大型欧洲SFTP患者队列中验证最近提出的复发评分。
在113例行SFTPs完整切除的患者中评估先前发表的评分系统的有效性。根据SFTPs的胸膜起源、形态、大小、细胞增多、坏死或出血情况以及有丝分裂数量对患者进行评分。绘制该评分的受试者工作特征曲线。使用Kaplan-Meier法和Cox比例风险法进行复发时间分析。
平均随访13.2±7.3年，有9例复发（8.0%）。预测复发的评分表现如下：敏感性=78%，特异性=74%，阳性似然比=3.0，阴性似然比=0.3。采用3分的临界值将79例患者（69.9%）分类为低复发风险，34例患者（30.1%）分类为高复发风险。高风险分类与随访期间更多的复发（P=.004）、更差的总生存期（P=.0008）、更广泛的肺切除（P=.001）以及辅助治疗的使用（P=.009）显著相关。在预测SFTP复发时，本评分优于英国标准（P=.049）和德佩罗分类法（P<.001）。
所提出的评分系统结合了切除的SFTPs的常见临床和组织学特征，在另一患者群体中仍能预测复发。这个简单的评分可为这种罕见肿瘤的术后监测提供指导。
