Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor
Menée auprès de 147 patients atteints d'une tumeur fibreuse pleuro-pulmonaire isolée (âge médian : 61,5 ans ; durée médiane de suivi : 5,5 ans), cette étude compare la performance de quatre modèles de stratification pour prédire le risque de récidive et la survie des patients
Introduction : Solitary fibrous tumors (SFT) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFT, but none have been universally endorsed and few have focused on pleuropulmonary SFT.
Methods : Histologic sections were examined from surgically resected pleuropulmonary SFT, with confirmatory immunohistochemistry. Patients were risk stratified using 4 prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan–Meier analysis estimated overall survival (OS) and progression-free survival (PFS).
Results : The 147 study patients included 78 females (53.1%), with a median age of 61.5 years (range 25-87). Median follow up was 5.5 years (range 0-33). Recurrence or metastasis occurred in 15 patients (10.2%), with 5 deaths from disease. Significant predictors of worse OS included male gender, age ≥ 55, size≥10 cm, non-pedunculated growth, severe atypia, necrosis, and mitoses ≥ 4/10 high powered fields (hpf). Predictors of recurrence included size ≥10 cm, severe atypia, necrosis, ≥4 mitosis/10 hpf, and Ki-67 ≥2%. All systems predicted PFS, but only Demicco and Tapias significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic=0.80 compared to 0.78).
Conclusion : Risk scoring systems proposed by Tapias and Demicco 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 providing best discrimination for PFS, and thus may be the best system to apply in general practice.
Journal of Thoracic Oncology , résumé, 2017