Schmid Severin, Csanadi Agnes, Kaifi Jussuf Thomas, Kübler Markus, Haager Benedikt, Kayser Gian, Passlick Bernward, Wiesemann Sebastian
Department of Thoracic Surgery, University Hospital Freiburg, Freiburg, Germany.
Department of Pathology, University Hospital Freiburg, Freiburg, Germany.
J Surg Res. 2015 May 15;195(2):580-7. doi: 10.1016/j.jss.2015.01.049. Epub 2015 Jan 30.
Solitary fibrous tumors of the pleura (SFTP) are rare neoplasms originating from submesothelial mesenchymal cells with fibroblastic differentiation. The clinical behavior of SFTPs is mostly benign; however, up to 20% of patients develop local recurrence and/or distant metastasis. Although different risk-stratification models have been described, definitive criteria to predict a malignant clinical course of SFTP are still lacking.
In a retrospective analysis at a single-institution, 25 patients with histologically proven SFTP were identified. Clinicopathologic and survival data were collected and pathologic sections reviewed. Different markers and risk-stratification models were correlated with disease- and overall-free survival by Kaplan-Meier analysis.
Of 25 SFTP, 8 tumors (32%) were classified as malignant according to the World Health Organization criteria. Three patients (12%) developed recurrence. Cohort median follow-up was 28 mo, and median overall survival was 160 mo. Comparison of proliferation markers showed higher mitosis count per high-power field and MIB-1 labeling index (MIB) in malignant compared with nonmalignant SFTP. MIB was identified as a predictor for disease-free survival. Applying the previously reported classifications to categorize SFTP according to the probability to show malignant behavior, significant differences in disease-free survival were also present in our cohort.
In the present analysis of rare SFTP, previously proposed staging systems were applicable for prediction of disease-free survival. Independently of treatment, MIB was the only sole predictive marker. A prospective multi-institutional database could be helpful in establishing detailed predictive criteria in patients diagnosed with SFTP.
胸膜孤立性纤维瘤（SFTP）是起源于具有成纤维细胞分化的间皮下间充质细胞的罕见肿瘤。SFTP的临床行为大多为良性；然而，高达20%的患者会出现局部复发和/或远处转移。尽管已经描述了不同的风险分层模型，但仍缺乏预测SFTP恶性临床病程的明确标准。
在一家机构进行的回顾性分析中，确定了25例经组织学证实为SFTP的患者。收集临床病理和生存数据，并复查病理切片。通过Kaplan-Meier分析将不同的标志物和风险分层模型与疾病无进展生存期和总生存期进行关联。
在25例SFTP中，根据世界卫生组织标准，8例肿瘤（32%）被分类为恶性。3例患者（12%）出现复发。队列的中位随访时间为28个月，中位总生存期为160个月。增殖标志物的比较显示，与非恶性SFTP相比，恶性SFTP的每高倍视野有丝分裂计数和MIB-1标记指数（MIB）更高。MIB被确定为无病生存期的预测指标。应用先前报道的分类方法根据显示恶性行为的概率对SFTP进行分类，我们的队列中无病生存期也存在显著差异。
在本次对罕见SFTP的分析中，先前提出的分期系统适用于预测无病生存期。独立于治疗，MIB是唯一的预测标志物。前瞻性多机构数据库可能有助于为诊断为SFTP的患者建立详细的预测标准。
