Li X L, Zhang H, Hu C C, Zhou J F, Zhuang M Y, Fan X X, Hu L W, Chen Y P, Huang Q, Zhang S, Wang X F
Department of Pathology, the Second Hospital of Longyan, Longyan 364000, China Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China.
Department of Radiology, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China Department of Radiology, Binhai Campus of the First Affiliated Hospital, National Regional Medical Center, Fujian Medical University, Fuzhou 350212, China.
Zhonghua Zhong Liu Za Zhi. 2025 Mar 23;47(3):275-282. doi: 10.3760/cma.j.cn112152-20240810-00336.
The 5th edition of the WHO classification of central nervous system (CNS) tumors in 2021 made significant revisions to the nomenclature and grading system of solitary fibrous tumors (SFT). This study aimed to explore the changes in the grading of CNS SFT and its relationship with clinical pathological features and prognosis. This study retrospectively reviewed the clinical and pathological data of 82 patients with CNS SFT diagnosed at the First Affiliated Hospital of Fujian Medical University from March 2006 to June 2021, reassessed their grading according to the WHO 5th edition CNS tumor classification, and conducted a comprehensive analysis of their histological morphology, immunohistochemical characteristics, and clinical imaging data. The age of the patients ranged from 21 to 83 years, with a median age of 48 years. Follow-up was completed for 82 patients, during which 10 patients died, 24 recurred, and 5 metastasized. MRI imaging showed that SFT exhibited isointense signals on T1-weighted imaging (T1WI) and complex signals on T2-weighted imaging (T2WI), with signal intensity decreasing as the content of collagen fibers increased. According to the 2021 grading criteria, there was a significant change in the grading of SFT, with the number of grade 1 SFT increasing from 10 cases under the 2016 standard to 39 cases, while the number of grade 2 and 3 SFT decreased accordingly. The 2016 grading system was significantly correlated with the overall survival (OS) of patients (=0.009), while the 2021 grading system did not reach statistical significance. Both grading systems were correlated with histological phenotype, Ki-67 index, mitotic figures, and necrosis (＜0.05). All cases expressed STAT6, and showed varying degrees of expression of vimentin, CD99, BCL-2, and CD34. The staining intensity of type Ⅳ collagen fibers, as analyzed semi-quantitatively, was correlated with the OS of the patients (=0.017). The new grading system for CNS SFT has undergone significant changes, and its association with OS requires further validation. In-depth study of the content and fine structure of collagen fibers in SFT may have important clinical significance for the prognosis assessment and the formulation of treatment plans for patients. Moreover, quantitative analysis of T2WI signal intensity may provide a new method for preoperative preliminary assessment of the collagen fiber content in SFT.
2021年世界卫生组织（WHO）中枢神经系统（CNS）肿瘤分类第5版对孤立性纤维瘤（SFT）的命名和分级系统进行了重大修订。本研究旨在探讨CNS SFT分级的变化及其与临床病理特征和预后的关系。本研究回顾性分析了2006年3月至2021年6月在福建医科大学附属第一医院确诊的82例CNS SFT患者的临床和病理资料，根据WHO第5版CNS肿瘤分类重新评估其分级，并对其组织形态学、免疫组化特征和临床影像资料进行综合分析。患者年龄为21至83岁，中位年龄为48岁。82例患者均完成随访，其中10例死亡，24例复发，5例转移。MRI成像显示，SFT在T1加权成像（T1WI）上呈等信号，在T2加权成像（T2WI）上呈复杂信号，信号强度随胶原纤维含量增加而降低。根据2021年分级标准，SFT分级有显著变化，1级SFT数量从2016年标准下的10例增加到39例，而2级和3级SFT数量相应减少。2016年分级系统与患者总生存期（OS）显著相关（=0.009），而2021年分级系统未达到统计学意义。两种分级系统均与组织学表型、Ki-67指数、有丝分裂象和坏死相关（＜0.05）。所有病例均表达STAT6，并显示波形蛋白、CD99、BCL-2和CD34不同程度的表达。半定量分析的Ⅳ型胶原纤维染色强度与患者OS相关（=0.017）。CNS SFT的新分级系统有显著变化，其与OS的相关性有待进一步验证。深入研究SFT中胶原纤维的含量和精细结构可能对患者的预后评估和治疗方案制定具有重要临床意义。此外，T2WI信号强度的定量分析可能为术前初步评估SFT中胶原纤维含量提供新方法。
