Solitary fibrous tumor of the pleura: outcomes of 157 complete resections in a single center

Abstract

Background: The purpose of this study was to identify factors affecting long-term outcomes after complete resection of solitary fibrous tumors of the pleura (SFTP).

Methods: This was a single-center retrospective study using data from patients operated on from January 1980 to December 2010.

Results: Of the 157 patients (72 men, 85 women; median age, 58 years [13-87 years]), 60 (38%) had symptoms. All patients had complete en bloc resection with wedge lung excision (n=122), lobectomy (n=15), bilobectomy (n=3), segmentectomy (n=1), pneumonectomy (n=4), chest wall resection (n=8), diaphragm resection (n=3), or multilevel hemivertebrectomy (n=1). The tumors were pedunculated (n=89) or sessile (n=68). Definitive histologic examination showed benign tumors (bSFTP) in 90 patients (57%) and malignant tumors (mSFTP) in 67 (43%) patients. Compared with the bSFTP group, the mSFTP group had significantly larger tumors (13.4 cm vs 6.4 cm; p<0.0001) and a nonsignificantly higher proportion of symptomatic patients (58% vs 23%). Overall operative mortality and morbidity rates were 0.6% and 5.7%, respectively, with no significant difference between patients with mSFTP and those with bSFTP. The 5-year survival rate was better in patients with bSFTP than in patients with mSFTP (96% vs 68%; p=0.0003). Tumor recurrence was more common in patients with mSFTP than in those with bSFTP (16% vs 2%; p<0.0001) and was associated with decreased survival (p=0.02). Sessile tumors (p=0.05), CD34-negative tumors (p=0.005), and extensive surgical procedures (p=0.04) were significant risk factors for tumor recurrence.

Conclusions: Complete en bloc resection of SFTP provides good long-term survival. Tumor recurrence is the main risk factor for death and may occur in mSFTP despite en bloc resection and requires multimodal treatment and close follow-up.