Predictors of behaviour in solitary fibrous tumours of the pleura surgically resected: Analysis of 107 patients

Risk factors for recurrent disease after resection of solitary fibrous tumor: a systematic review

Introduction

Solitary fibrous tumor (SFT) is a rare soft tissue tumor found at any site of the body. The treatment of choice is surgical resection, though 10%-30% of patients experience recurrent disease. Multiple risk factors and risk stratification systems have been investigated to predict which patients are at risk of recurrence. The main goal of this systematic review is to create an up-to-date systematic overview of risk factors and risk stratification systems predicting recurrence for patients with surgically resected SFT within torso and extremities.

Method

We prepared the review following the updated Prisma guidelines for systematic reviews (PRISMA-P). Pubmed, Embase, Cochrane Library, WHO international trial registry platform and ClinicalTrials.gov were systematically searched up to December 2022. All English studies describing risk factors for recurrence after resected SFT were included. We excluded SFT in the central nervous system and the oto-rhino-laryngology region.

Results

Eighty-one retrospective studies were identified. Different risk factors including age, symptoms, sex, resection margins, anatomic location, mitotic index, pleomorphism, hypercellularity, necrosis, size, dedifferentiation, CD-34 expression, Ki67 index and TP53-expression, APAF1-inactivation, TERT promoter mutation and NAB2::STAT6 fusion variants were investigated in a narrative manner. We found that high mitotic index, Ki67 index and presence of necrosis increased the risk of recurrence after surgically resected SFT, whereas other factors had more varying prognostic value. We also summarized the currently available different risk stratification systems, and found eight different systems with a varying degree of ability to stratify patients into low, intermediate or high recurrence risk.

Conclusion

Mitotic index, necrosis and Ki67 index are the most solid risk factors for recurrence. TERT promoter mutation seems a promising component in future risk stratification models. The Demicco risk stratification system is the most validated and widely used, however the G-score model may appear to be superior due to longer follow-up time.

Systematic Review Registration

CRD42023421358.

Surgery for Solitary Fibrous Tumors of the Pleura: A Review of the Available Evidence

Solitary fibrous tumors of the pleura (pSFT) are a relatively rare neoplasms that can arise from either visceral or parietal pleura and may have different aggressive biological behaviors. Surgery is well known to be the cornerstone of the treatment for pSFT. We reviewed the existing literature, focusing on the role of surgery in the management and treatment of pSFT. All English-written literature has been reviewed, focusing on those reporting on the perioperative management and postoperative outcomes. Surgery for pSFT is feasible and safe in all experiences reported in the literature, but surgical approaches and techniques may vary according to the tumor dimensions, localization, and surgeons' skills. Long-term outcomes are good, with a 10-year overall survival rate of more than 70% in most of the reported experiences; on the other hand, recurrence may happen in up to 17% of cases, which occurs mainly in the first two years after surgery, but case reports suggest the need for a longer follow-up to assess the risk of late recurrence. Malignant histology and dimensions are the most recognized risk factors for recurrence. Recurrence might be operated on in select patients. Surgery is the treatment of choice in pSFT, but a radical resection and a careful postoperative follow-up should be carried out.

Management of solitary fibrous tumours of the pleura: a systematic review and meta-analysis

Background

Solitary fibrous tumours of the pleura (SFTP), or pleural fibromas, are rare tumours that generally, but not universally, follow a benign course. Surgical resection is the standard treatment, but there are no evidence-based guidelines regarding the management of these tumours.

Methods

Five databases were searched from inception to April 1, 2019 for studies reporting on SFTP management.

Results

Twenty-seven studies met the inclusion criteria (1542 patients, all non-comparative case series); 98% of these patients underwent resection and all SFTP included were pathologically diagnosed. 394 out of 1299 cases (30.5%, 95% CI 27.8–32.8%) were malignant with recurrence rates of between 0% and 42.9%. A pleural effusion was always associated with a negative outcome, but no other features were consistently reported to have negative associations. Preoperative biopsies incorrectly reported malignant histology in two studies. Over 25% of cases of recurrence occurred when a complete (R0) resection had been achieved. The first recurrence occurred >5 years after the initial resection in at least 23% of cases.

Conclusions

There is strong evidence to support long-term surveillance after surgical resection of SFTP, even where a complete (R0) resection has been achieved; however, there is no clear evidence to inform clinicians regarding the selection of patients who should undergo resection. The rates of malignant SFTP and SFTP recurrence are higher than previously reported. Only those that were pathologically diagnosed or resected were included, which may bias the data towards more aggressive tumours. Data collection on radiologically diagnosed SFTP is required to draw conclusions regarding the timing and need for intervention.

Long-term surveillance should be undertaken after a resection of solitary fibrous tumours of the pleura but further work is needed to determine which patients are likely to follow a malignant clinical course to decide timing and necessity of a resectionhttps://bit.ly/2U10SaA

Thoracic solitary fibrous tumors: an analysis of 70 patients who underwent surgical resection in a single institution

BACKGROUND

Thoracic solitary fibrous tumors (TSFTs) are uncommon mesenchymal tumors. The data regarding surgical outcomes and prognostic factors are scarce. This retrospective paper is to analyze surgical outcomes, clinical characteristics and prognosis of TSFT.

METHODS

A single-center retrospective study of the data of 70 patients with TSFT who underwent surgical resection in our department between August 2008 and October 2014 was conducted.

RESULTS

A total of 70 TSFTs (58 benign, 12 malignant) were included and all patients underwent complete surgical resection except one recurrent patient with initial treatment. TSFTs originated from the pleura (n = 43), lung (n = 9), mediastinum (n = 16), esophagus (n = 1) and diaphragm (n = 1), respectively. Mass excision was only performed in 29 patients, en bloc excision including surrounding structures was performed in 41 patients. During follow-up, no tumor recurrence occurred in benign TSFT patients. All recurrences occurred in 6 malignant patients, and 5 of them died because of local recurrence and distant metastasis. Median follow-up was 95 months (range, 3-133 months). The 5-year overall survival (OS) of TSFT patients was 94.3%. The 5-year relapse-free survival and OS of malignant TSFT patients were 58.3% and 66.7%, respectively.

CONCLUSION

The gold standard of TSFT treatment is complete surgical resection. VATS is safe and reliable for treating selected TSFT patients. Aggressive surgical resection could be underwent in such patients of local recurrence or solitary metastatic tumor. A long-term follow-up is necessary due to the risk of recurrence.