Bellini Alice, Marulli Giuseppe, Breda Cristiano, Ferrigno Pia, Terzi Stefano, Lomangino Ivan, Lo Giudice Fabio, Brombin Claudia, Laurino Licia, Pezzuto Federica, Calabrese Fiorella, Rea Federico
Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University Hospital of Padova, Padova, Italy.
Thoracic Surgery Unit, Department of Organ Transplantation and Emergency, University Hospital of Bari, Bari, Italy.
J Surg Oncol. 2019 Sep;120(4):761-767. doi: 10.1002/jso.25634. Epub 2019 Jul 16.
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.
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]).
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.
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.
胸膜孤立性纤维瘤的金标准治疗方法是完整手术切除。这项回顾性研究的目的是评估肿瘤学和手术结果，并验证文献中提出的预后评分的临床可靠性。
研究人群：1972年至2018年间接受手术治疗的107例患者。男女比例：1/2.45；手术时的中位年龄：60岁（范围19 - 80岁）；带蒂病变占69.8%；起源于脏层胸膜占72.9%；良性组织学占73.8%；中位直径8厘米（范围1至35厘米，27例巨大肿瘤[≥15厘米]）。
中位随访7年后，12例患者复发。通过多变量分析，恶性组织学（P = 0.03；HR，4.17；95% CI，1.15 - 15.06）、起源于壁层胸膜（P = 0.03；HR，3.90；95% CI，1.08 - 14.09）、英格兰（P = 0.002；HR，1.98；95% CI，1.28 - 3.07）、迪博尔德（P = 0.008；HR，1.96；95% CI，1.20 - 3.22）和塔皮亚斯（P = 0.003；HR，1.75；95% CI，1.20 - 2.53）评分被发现是复发的独立显著预测因素。巨大肿瘤与开放手术（P = 0.003）、起源于壁层胸膜（P = 0.011）和术中出血（P > 0.001）相关。总体10年无病生存率（DFS）为81%。最差DFS的预测因素是起源于壁层胸膜（P = 0.002）、恶性组织学（P = 0.006）和所有预后评分。
恶性组织学和起源于壁层胸膜是肿瘤复发和最差DFS的显著预测因素。使用当前的评分系统有助于预测临床行为。复发风险较高的患者可从延长至10年以上的密切随访中获益。
