Silverwood R, Jayasankar V, Mahendra A, Gupta S, MacDuff E
Department of Musculoskeletal Oncology, Trauma & Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK.
Department of Pathology, Queen Elizabeth University Hospital, Glasgow, UK.
J Clin Orthop Trauma. 2021 Nov 3;24:101675. doi: 10.1016/j.jcot.2021.101675. eCollection 2022 Jan.
Solitary fibrous tumours (SFT) are a type of mesenchymal tumour. Whilst the majority of cases follow an indolent course a significant proportion of patients suffer metastases or disease recurrence post-surgical excision. Due to the unpredictable clinical course follow up duration and intensity remains contentious.
We aimed to determine current outcomes of management of this tumour, apply and assess current risk recurrence models to determine if our standard of care could be improved upon.
A prospective database of patients treated at a regional musculoskeletal oncology service was assessed. Only extra-pleural, extra-meningeal SFTs were included in the study. Surgical outcome and post-operative investigations were scrutinised and the Pasquali and Demicco recurrence risk models were applied and assessed.
From 2009 to 2019 12 patients were identified, 8 female and 4 males. Their age at diagnosis ranged from 21 to 76 years. 11 patients underwent surgery with curative intent and no patient suffered disease progression or recurrence, with a mean follow up time of 41 months. One patient presented with metastatic disease and was managed palliatively.
Following this review of our case series and utilising risk recurrence models published in the literature we have changed our follow up protocol. In new cases of SFT the Pasquali prognostic model, with the addition of the presence or absence of necrosis, will be utilised. If a patient has benign features on initial biopsy we propose to not perform staging. Furthermore, if biopsy and final pathology results remain concordant, with no concerning features, and the patient has undergone complete excision reduced intensity follow up could be considered. Level IV, retrospective case series.
孤立性纤维性肿瘤（SFT）是一种间叶组织肿瘤。虽然大多数病例病程呈惰性，但相当一部分患者在手术切除后会发生转移或疾病复发。由于临床病程不可预测，随访时间和强度仍存在争议。
我们旨在确定该肿瘤目前的治疗结果，应用并评估当前的复发风险模型，以确定我们的治疗标准是否可以改进。
对一个地区肌肉骨骼肿瘤服务机构治疗的患者的前瞻性数据库进行了评估。本研究仅纳入胸膜外、脑膜外的SFT。对手术结果和术后检查进行了仔细审查，并应用和评估了帕斯夸利（Pasquali）和德米科（Demicco）复发风险模型。
2009年至2019年共确定12例患者，8例女性，4例男性。他们的诊断年龄在21岁至76岁之间。11例患者接受了根治性手术，无患者出现疾病进展或复发，平均随访时间为41个月。1例患者出现转移性疾病，接受了姑息治疗。
在对我们的病例系列进行回顾并利用文献中发表的复发风险模型后，我们改变了随访方案。在新的SFT病例中，将使用帕斯夸利预后模型，并增加有无坏死的情况。如果患者在初次活检时具有良性特征，我们建议不进行分期。此外，如果活检和最终病理结果一致，没有令人担忧的特征，并且患者已接受完整切除，则可以考虑降低随访强度。四级，回顾性病例系列。
