Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor

Janani S. Reisenauer, Wadad Mneimneh, Sarah Jenkins, Aaron Mansfield, Marie Christine Aubry, Karen J. Fritchie, Mark S. Allen, Shanda H. Blackmon, Stephen D. Cassivi, Francis C. Nichols, Dennis A Wigle, K. Robert Shen, Jennifer M. Boland

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFTs, but none has been universally endorsed and few have focused on pleuropulmonary SFTs. Methods: Histologic sections from surgically resected pleuropulmonary SFTs were examined, with confirmatory immunohistochemistry. Patients were risk-stratified by using four prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan-Meier analysis was used to estimate 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). The median follow-up was 5.5 years (range 0–33). Recurrence or metastasis occurred in 15 patients (10.2%), with five deaths from disease. Significant predictors of worse OS included male sex, age at least 55 years, tumor size at least 10 cm, nonpedunculated growth, severe atypia, necrosis, and mitotic count of at least four per 10 high-power fields. Predictors of recurrence included tumor size of at least 10 cm, severe atypia, necrosis, at least four mitoses per 10 high-power fields, and Ki67 labeling index of at least 2%. All systems predicted PFS, but only the Demicco and Tapias systems significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic = 0.80 compared with 0.78). Conclusion: The risk scoring systems proposed by Tapias et al. and Demicco et al. 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 provision of the best discrimination for PFS, and thus may be the best system to apply in general practice.

Original languageEnglish (US)
JournalJournal of Thoracic Oncology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Solitary Fibrous Tumors
Disease-Free Survival
Recurrence
Survival
Necrosis
Neoplasms
Kaplan-Meier Estimate
Mitosis
General Practice
Immunohistochemistry
Neoplasm Metastasis
Growth

Keywords

  • Lung
  • Pleura
  • Risk stratification
  • Solitary fibrous tumor

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine

Cite this

Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor. / Reisenauer, Janani S.; Mneimneh, Wadad; Jenkins, Sarah; Mansfield, Aaron; Aubry, Marie Christine; Fritchie, Karen J.; Allen, Mark S.; Blackmon, Shanda H.; Cassivi, Stephen D.; Nichols, Francis C.; Wigle, Dennis A; Shen, K. Robert; Boland, Jennifer M.

In: Journal of Thoracic Oncology, 01.01.2018.

Research output: Contribution to journalArticle

Reisenauer, JS, Mneimneh, W, Jenkins, S, Mansfield, A, Aubry, MC, Fritchie, KJ, Allen, MS, Blackmon, SH, Cassivi, SD, Nichols, FC, Wigle, DA, Shen, KR & Boland, JM 2018, 'Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor', Journal of Thoracic Oncology. https://doi.org/10.1016/j.jtho.2018.05.040
Reisenauer, Janani S. ; Mneimneh, Wadad ; Jenkins, Sarah ; Mansfield, Aaron ; Aubry, Marie Christine ; Fritchie, Karen J. ; Allen, Mark S. ; Blackmon, Shanda H. ; Cassivi, Stephen D. ; Nichols, Francis C. ; Wigle, Dennis A ; Shen, K. Robert ; Boland, Jennifer M. / Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor. In: Journal of Thoracic Oncology. 2018.
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title = "Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor",
abstract = "Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFTs, but none has been universally endorsed and few have focused on pleuropulmonary SFTs. Methods: Histologic sections from surgically resected pleuropulmonary SFTs were examined, with confirmatory immunohistochemistry. Patients were risk-stratified by using four prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan-Meier analysis was used to estimate 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). The median follow-up was 5.5 years (range 0–33). Recurrence or metastasis occurred in 15 patients (10.2{\%}), with five deaths from disease. Significant predictors of worse OS included male sex, age at least 55 years, tumor size at least 10 cm, nonpedunculated growth, severe atypia, necrosis, and mitotic count of at least four per 10 high-power fields. Predictors of recurrence included tumor size of at least 10 cm, severe atypia, necrosis, at least four mitoses per 10 high-power fields, and Ki67 labeling index of at least 2{\%}. All systems predicted PFS, but only the Demicco and Tapias systems significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic = 0.80 compared with 0.78). Conclusion: The risk scoring systems proposed by Tapias et al. and Demicco et al. 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 provision of the best discrimination for PFS, and thus may be the best system to apply in general practice.",
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T1 - Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor

AU - Reisenauer, Janani S.

AU - Mneimneh, Wadad

AU - Jenkins, Sarah

AU - Mansfield, Aaron

AU - Aubry, Marie Christine

AU - Fritchie, Karen J.

AU - Allen, Mark S.

AU - Blackmon, Shanda H.

AU - Cassivi, Stephen D.

AU - Nichols, Francis C.

AU - Wigle, Dennis A

AU - Shen, K. Robert

AU - Boland, Jennifer M.

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N2 - Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFTs, but none has been universally endorsed and few have focused on pleuropulmonary SFTs. Methods: Histologic sections from surgically resected pleuropulmonary SFTs were examined, with confirmatory immunohistochemistry. Patients were risk-stratified by using four prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan-Meier analysis was used to estimate 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). The median follow-up was 5.5 years (range 0–33). Recurrence or metastasis occurred in 15 patients (10.2%), with five deaths from disease. Significant predictors of worse OS included male sex, age at least 55 years, tumor size at least 10 cm, nonpedunculated growth, severe atypia, necrosis, and mitotic count of at least four per 10 high-power fields. Predictors of recurrence included tumor size of at least 10 cm, severe atypia, necrosis, at least four mitoses per 10 high-power fields, and Ki67 labeling index of at least 2%. All systems predicted PFS, but only the Demicco and Tapias systems significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic = 0.80 compared with 0.78). Conclusion: The risk scoring systems proposed by Tapias et al. and Demicco et al. 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 provision of the best discrimination for PFS, and thus may be the best system to apply in general practice.

AB - Introduction: Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFTs, but none has been universally endorsed and few have focused on pleuropulmonary SFTs. Methods: Histologic sections from surgically resected pleuropulmonary SFTs were examined, with confirmatory immunohistochemistry. Patients were risk-stratified by using four prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan-Meier analysis was used to estimate 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). The median follow-up was 5.5 years (range 0–33). Recurrence or metastasis occurred in 15 patients (10.2%), with five deaths from disease. Significant predictors of worse OS included male sex, age at least 55 years, tumor size at least 10 cm, nonpedunculated growth, severe atypia, necrosis, and mitotic count of at least four per 10 high-power fields. Predictors of recurrence included tumor size of at least 10 cm, severe atypia, necrosis, at least four mitoses per 10 high-power fields, and Ki67 labeling index of at least 2%. All systems predicted PFS, but only the Demicco and Tapias systems significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic = 0.80 compared with 0.78). Conclusion: The risk scoring systems proposed by Tapias et al. and Demicco et al. 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 provision of the best discrimination for PFS, and thus may be the best system to apply in general practice.

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KW - Solitary fibrous tumor

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