Division of Thoracic Surgery, Mayo Clinic, Rochester, Minnesota.
Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota.
J Thorac Oncol. 2018 Sep;13(9):1349-1362. doi: 10.1016/j.jtho.2018.05.040. Epub 2018 Jun 20.
Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFTs, but none has been universally endorsed and few have focused on pleuropulmonary SFTs.
Histologic sections from surgically resected pleuropulmonary SFTs were examined, with confirmatory immunohistochemistry. Patients were risk-stratified by using four prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan-Meier analysis was used to estimate overall survival (OS) and progression-free survival (PFS).
The 147 study patients included 78 females (53.1%) with a median age of 61.5 years (range 25-87). The median follow-up was 5.5 years (range 0-33). Recurrence or metastasis occurred in 15 patients (10.2%), with five deaths from disease. Significant predictors of worse OS included male sex, age at least 55 years, tumor size at least 10 cm, nonpedunculated growth, severe atypia, necrosis, and mitotic count of at least four per 10 high-power fields. Predictors of recurrence included tumor size of at least 10 cm, severe atypia, necrosis, at least four mitoses per 10 high-power fields, and Ki67 labeling index of at least 2%. All systems predicted PFS, but only the Demicco and Tapias systems significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic = 0.80 compared with 0.78).
The risk scoring systems proposed by Tapias et al. and Demicco et al. were both predictive of OS and PFS. The Demicco system has the advantages of simplicity and applicability to SFTs from other sites, as well as provision of the best discrimination for PFS, and thus may be the best system to apply in general practice.
孤立性纤维瘤（SFT）是一种罕见的间叶性肿瘤。大多数为良性，但有一部分会复发或转移。目前已经提出了各种 SFT 的风险分层方案，但没有一种方案得到普遍认可，而且很少有方案专门针对胸膜肺 SFT。
对手术切除的胸膜肺 SFT 组织学切片进行检查，并进行免疫组织化学确认。根据 de Perrot、Demicco（原始和改良）和 Tapias 提出的四个预测模型对患者进行风险分层。Kaplan-Meier 分析用于估计总生存期（OS）和无进展生存期（PFS）。
本研究共纳入 147 例患者，其中 78 例为女性（53.1%），中位年龄为 61.5 岁（范围 25-87 岁）。中位随访时间为 5.5 年（范围 0-33 年）。15 例患者（10.2%）出现复发或转移，其中 5 例因疾病死亡。OS 较差的显著预测因素包括男性、年龄至少 55 岁、肿瘤大小至少 10cm、无蒂生长、重度异型性、坏死和至少每 10 个高倍视野有 4 个分裂象。复发的预测因素包括肿瘤大小至少 10cm、重度异型性、坏死、至少每 10 个高倍视野有 4 个分裂象和 Ki67 标记指数至少 2%。所有系统均预测了 PFS，但只有 Demicco 和 Tapias 系统显著预测了 OS。改良 Demicco 系统对 PFS 的预测效果最好（C 统计量为 0.80，而 0.78）。
Tapias 等人和 Demicco 等人提出的风险评分系统均可预测 OS 和 PFS。Demicco 系统具有简单性和适用性，可以应用于其他部位的 SFT，并且对 PFS 的预测效果最佳，因此可能是一般实践中应用的最佳系统。
