Solitary fibrous tumors of the pleura: Results of surgical treatment and long-term prognosis

Abstract

Objective We sought to define the long-term outcome of surgically treated solitary fibrous tumors of the pleura. Methods We performed a retrospective review from December 1972 through December 2002. Results There were 84 patients (39 men and 45 women) with a median age of 57 years (range, 34–83 years). Forty-six patients were symptomatic. Surgical resection included pulmonary wedge excision in 62 patients, lobectomy in 4 patients, segmentectomy in 2 patients, chest wall resection in 3 patients, isolated pleural resection in 7 patients, and chest wall resection with pulmonary wedge excision, lobectomy, or pneumonectomy in 3, 2, and 1 patients, respectively. Tumors were polypoid in 57 patients, sessile in 20 patients, and intrapulmonary in 7 patients. Histopathology was benign in 73 and malignant in 11 patients. Nine (82%) patient with malignant tumors and 37 (54%) patients with benign tumors were symptomatic (P = .11). The median tumor diameters for malignant and benign tumors were 12.0 and 4.5 cm, respectively (P = .001). Operative mortality and morbidity occurred in 3 (3.6%) and 7 (8.1%) patients, respectively. Median follow-up in survivors was 146 months (range, 23–387 months). Median survival for patients with benign and malignant tumors was 284 and 55 months, respectively, and 5-year survival was 88.9% and 45.5%, respectively (P = .0005). Eight (9.5%) patients had recurrent solitary fibrous tumors of the pleura. Recurrences were malignant in 6 and benign in 2 patients. Localized chest recurrences occurred in 3 patients, all of whom had reresection, with 2 patients again having recurrence. Conclusion Resection of benign solitary fibrous tumors of the pleura carries an excellent prognosis. Larger tumors are more likely to be malignant. Both benign and malignant tumors can recur. Although prolonged survival after resection of malignant tumors is possible, recurrence is common.

Validation of a Scoring System to Predict Recurrence of Resected Solitary Fibrous Tumors of the Pleura

“…10 Nonetheless, in spite of a higher proportion of patients exhibiting tumor characteristics associated with malignant behavior, we only observed a recurrence rate of 8%, compared with a 14% recurrence rate reported in the American population 10 and a 10% to 15% recurrence rate reported in contemporary surgical series. [2][3][4][5][6] We have also demonstrated that the proposed score performed signifi cantly better in this validation population compared with previously published criteria to determine malignant behavior, specifi cally, the criteria by England et al 8 and the classifi cation by de Perrot et al 9 Additionally, the scoring system remained valid upon classifying patients according to their risk of SFTP recurrence when using a cutoff of 3 points. In patients classifi ed at low risk ( , 3 points), we observed very low recurrence rates of 1.3%, 1.3%, and 3.5% at 5, 10, and 15 years, respectively, compared with recurrence rates of 13.5%, 17.5%, and 27.9% in patients classifi ed at high risk ( Ն 3 points).…”

“…Th e infrequent presentation of SFTPs has limited their study to mostly case reports and single-institution case series. [2][3][4][5][6][7] Since 1989, 8 factors associated with SFTP malignant behavior have been recognized. However, surgical series have used diff erent criteria to classify tumors as "malignant."…”

“…However, surgical series have used diff erent criteria to classify tumors as "malignant." [2][3][4][5][6][7] Th is lack of uniformity across surgical series makes the extrapolation of results or the pooling of data diffi cult. Th erefore, criteria to identify malignant behavior of SFTPs require standardization.…”

“…1 Surgical resection is the treatment of choice for most patients, achieving high cure rates. [2][3][4][5][6][7] However, approximately 10% to 15% of patients experience SFTP recurrence aft er surgery, [2][3][4][5][6][7] which in some cases can lead to death. In a landmark study, England et al 8 recognized SFTP characteristics that were associated with malignant behavior aft er analyzing the largest sample of SFTPs ever published.…”

“…Despite these criteria, published surgical series have failed to use standardized criteria to classify SFTPs as "malignant. " [2][3][4][5][6][7] To classify patients with SFTP according to their risk of recurrence is relevant, as this would result in more appropriate postoperative surveillance protocols and may identify patients who would benefi t from adjuvant therapies. Currently, surveillance aft er surgery is guided by recommendations from experts stating that radiologic examination should be performed at least yearly in all patients.…”